Lung Cancer in India: Why Screening Remains a Challenge

06 Oct 2026

Tags: Social Justice   Social Services   Health sector issues

Source: The Indian Express

Context: Lung cancer is the leading cause of cancer deaths in India, accounting for 10.9% of all cancer deaths in 2024 (98,687 deaths), up from 75,031 deaths in 2022.

• Despite its rising burden, India does not have a nationwide lung-cancer screening programme, unlike screening programmes for breast, oral and cervical cancers.
• The central challenge is to identify high-risk individuals early while balancing cost, accessibility, false positives and India's distinct risk profile.

Why is Early Screening Necessary?

• New lung-cancer cases increased from 81,748 (5.8% of all cancer cases) in 2022 to 1.12 lakh (7.2%) in 2024, moving lung cancer from the fourth to the third most common cancer.
• Mortality increased from 8.2% to 10.9% of all cancer deaths during the same period.
• Lung cancer is often detected at an advanced stage, when treatment becomes more difficult and survival falls significantly.
• The likelihood of surviving five years can rise to around 80% when lung cancer is detected at Stage I, highlighting the potential value of early detection.
• However, lung cancer is currently not routinely screened in India, unlike breast, oral and cervical cancers.

Why is India Not Increasing Lung-Cancer Screening?

1. High Cost of Screening

• Low-dose computed tomography (LDCT) is the preferred screening technology, but it is considerably more expensive than routine screening methods used for breast, oral and cervical cancers.
• The Indian Council of Medical Research (ICMR) compared LDCT, chest X-rays and no screening for a hypothetical high-risk population and found LDCT to have the highest cost but also the highest net monetary benefit.
• The study described LDCT as a cost-effective strategy and recommended considering its integration into national cancer-screening programmes.

2. Limited Availability of LDCT

• LDCT requires people to travel to centres equipped with appropriate CT-scanning facilities, which are generally unavailable at primary health centres.
• Even where CT machines exist, LDCT is usually performed when a doctor already suspects a medical condition rather than as a routine screening test.
• Therefore, expanding screening would require substantial investment in diagnostic infrastructure and referral networks.

3. India's Different Risk Profile

• Current international screening guidelines largely focus on people with a substantial cigarette-smoking history, but India has a large population of beedi smokers for whom equivalent screening criteria are not well established.
• India also has significant exposure to second-hand smoke, biomass fuel, domestic smoke and occupational fumes, which may contribute to lung-cancer risk.
• Ambient air pollution is also emerging as an important potential risk factor.
• Hence, directly applying Western screening criteria may leave a substantial proportion of India's high-risk population outside the screening net.

LDCT: Why is it Important?

• LDCT (Low-Dose Computed Tomography) uses a lower radiation dose than conventional CT while producing detailed images of the lungs.
• It can detect small lung nodules and early-stage cancers before symptoms become apparent.
• The ICMR analysis found that although LDCT has the highest screening cost, its potential health benefits and monetary benefits make it a potentially cost-effective intervention.
• The challenge is therefore not only whether LDCT works, but whether India can make it affordable, accessible and appropriately targeted.

Concern Over False Positives: Tuberculosis (TB)

• A major concern is that India's high prevalence of tuberculosis could lead to lung abnormalities being mistaken for cancer, increasing false-positive results.
• A Mumbai pilot study published in 2021 found that even in a TB-endemic country, LDCT could identify malignant lung nodules early and save lives.
• A 2025 study by AIIMS doctors also reported that TB prevalence did not pose a significant problem for lung-cancer screening.
• Thus, available Indian evidence suggests that TB should be considered in screening protocols but need not necessarily be a barrier to LDCT-based screening.

Who Should be Screened?

Existing Approach

• Current international guidelines generally recommend LDCT for people in specified older age groups with substantial cigarette-smoking histories.
• However, this approach may not adequately capture India's diverse sources of exposure and large population of non-cigarette tobacco users.

Broader Indian Risk Factors

• An Indian researchers' 2024 expert opinion statement suggested including people with:
  • Beedi-smoking history
  • Second-hand smoke exposure
  • Biomass-fuel exposure
  • Domestic smoke
  • Occupational fumes/exposures
• Ambient air pollution may also emerge as an important criterion as evidence on its contribution to lung-cancer risk develops.

Evidence from Indian Studies

• The Indian Lung Screening Trial has generated evidence supporting the use of LDCT for early detection in the Indian context.
• The AIRCARE (Air Pollution and Cancer Research Ecosystem) initiative is examining the contribution of air pollution and other environmental exposures to lung-cancer risk.
• Such India-specific evidence is important because risk factors and disease patterns in India differ from those in countries where existing screening guidelines were developed.

Role of Smoking Cessation

• A significant proportion of lung cancers may not be directly linked to smoking, but smoking cessation remains one of the most effective ways to reduce lung-cancer risk.
• Among lung-cancer patients, quitting smoking can improve treatment outcomes and survival prospects.
• Public-health messaging should therefore go beyond simply stating that smoking causes cancer and provide people with actionable information about when and why screening may be appropriate, particularly among older long-term smokers.

Existing Cancer-Screening Approach in India

• India's government-supported cancer-screening efforts at the primary healthcare level have traditionally focused on breast, oral and cervical cancers.
• Lung-cancer screening is more technically and financially demanding because it requires CT-based imaging, specialised interpretation and mechanisms for managing detected nodules.
• Any national lung-screening programme would therefore require integration of screening, diagnosis, referral and treatment, rather than merely increasing access to CT scans.

Key Challenges for India

• High cost: LDCT is more expensive than existing population-level screening methods.
• Infrastructure gap: CT facilities and trained personnel are unevenly distributed, particularly at the primary-care level.
• Risk identification: Conventional cigarette-smoking criteria may not capture India's full high-risk population.
• False positives: TB and other lung conditions can complicate interpretation, although Indian evidence suggests this is manageable.
• Environmental exposure: Biomass smoke, occupational exposure and air pollution require greater consideration in risk assessment.
• Equity: Screening should reach high-risk populations without creating excessive financial or geographical barriers.

Way Forward

• India could consider targeted, risk-based LDCT screening rather than indiscriminate population-wide screening.
• Screening criteria should be adapted to Indian risk factors, including beedi use and relevant environmental and occupational exposures.
• Expansion should be accompanied by CT infrastructure, trained personnel, standardised protocols and referral pathways to prevent screening without adequate follow-up.
• Evidence from Indian studies should guide the development of India-specific screening guidelines.
• Tobacco cessation and pollution-control measures should remain central to lung-cancer prevention alongside early detection.