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Improving Early Detection of Oral, Breast, and Cervical Cancer in India

Evaluating evidence-based strategies to improve the quality and accessibility of early cancer detection in rural areas in India

Breast, cervical, and oral cancers are among the three most prevalent cancers in India, accounting for a third of cancer cases. Over 70% of India’s population of 1.3 billion people live in rural areas, where cancer has a particularly harmful impact.

Cancer diagnoses in rural India are often delayed until the disease has progressed to an advanced stage, resulting in worse health outcomes, including higher mortality rates, and higher household expenditures, since cancer treatment costs are among the highest of any disease. Over 60% of Indian households seeking private sector cancer care incur catastrophic treatment costs exceeding one fifth of annual household expenditure, with higher rates of expenditure seen in rural areas than urban ones. Rural populations also experience worse treatment outcomes than their urban counterparts, with significantly higher fatality rates for common cancers like breast and oral cancer.

Early cancer detection interventions targeting women in rural areas demonstrate enormous potential for improving health outcomes in light of the urban-rural differences in healthcare seeking behavior, quality and accessibility of care, the prevalence of cancers affecting women, and the disparity of treatment costs.

Access Cancer Care India Study

Through the Global Alliance for Chronic Diseases (GACD)’s Access Cancer Care India study, RTI and partners are performing implementation research on several evidence-based strategies to improve the quality and accessibility of early cancer detection in rural areas in India.

The study is evaluating which strategies are most effective, flexible, and responsive to local needs, and determining which factors influence these capabilities. It will also assess the scalability and sustainability of the most effective interventions.

The goal of the Access Cancer Care India study is not only to identify effective policies and best practices in early cancer detection, but also to assess the impact of the COVID-19 pandemic on early cancer detection and treatment in India. In the post-COVID-19 era, there is an urgent need to evaluate promotive healthcare and tailor delivery of health services to reach vulnerable populations.

Stakeholder Engagement

RTI is conducting the Access Cancer Care India study alongside a team of research partners from King’s College London, the International Agency for Research on Cancer, Karkinos Healthcare, Adyar Cancer Institute, and the American International Institute of Medical Sciences in Udaipur.

In 2022, representatives from each of these organizations, along with experts from the RTI Center for Global Noncommunicable Diseases, met in Kochi and Chennai, India, to create a plan for stakeholder engagement in the implementation research. Stakeholders include individuals, organizations, and institutions which are either affected by, or have the power to affect, early cancer detection interventions.

Stakeholder engagement is a critical component of implementation science and public health research. Collaborative dialogues with stakeholders and affected parties increase the relevance of research questions, so that findings can become more responsive to the needs of those groups. Particularly in resource-constrained health systems, improvements in access and affordability need to be designed in concert with patient groups, public and private providers, policymakers, and civil society so that early cancer detection strategies respond to the local health context and patient experience.