Asha (name changed), a teacher from Delhi, had her life changed by a lump. It eventually led to a mastectomy, the removal of one of her breasts. For this 40-year-old mother of two, she not only endured the pain of the process but also had to come to terms with a body that no longer looked the way it once did. But over time, she has come to see the loss differently. "The surgery removed a diseased organ and is in no way a loss of my identity as a woman". What has changed is her awareness: she knows she must be more careful than ever. Flu season makes her wary; COVID forced her to lock herself down even when others resumed normal life. But she says she is grateful, as many like her are not alive to do so.
In another city, another mother of two lost her battle with breast cancer even after two surgeries. She was diagnosed at stage three of the disease. She felt a lump in her breast but delayed seeking medical help, believing it was nothing to worry about because it did not hurt. By the time she realised, it was too late.
These two stories show a side of breast cancer that statistics cannot fully convey: the physical and emotional adjustments women make, and the importance of recognising the disease before it advances.
The contrast between the two stories stresses a crucial message about breast cancer: a lump does not have to hurt to be dangerous. Dr Geeta Chadha, a renowned obstetrician and gynaecologist at Indraprastha Apollo, Delhi, says "she is increasingly concerned about women who come to her with painless lumps", highlighting the need to recognise that the absence of pain is no reason to delay a medical consultation.
What do the numbers say
Breast cancer has emerged as one of India's biggest cancer challenges and was the most common form of cancer diagnosed in Indian women. Yet the challenge is not simply the number of women developing the disease. It also depends on whether they recognise the warning signs, reach a health facility in time, and receive an accurate diagnosis and appropriate treatment.
According to the International Agency for Research on Cancer's (IARC) GLOBOCAN 2022 estimates, India recorded approximately 192,020 new breast cancer cases and 98,337 deaths that year. Breast cancer was the most frequently diagnosed cancer among Indian women and accounted for roughly one in four new cancer diagnoses in women.
These are estimates, not a count of every case in the country but yet underline the scale of the problem. India ranks among the countries reporting the highest numbers of breast cancer cases and recorded the world's highest number of breast cancer deaths in 2022.
“Breast cancer is now the most commonly diagnosed cancer in India. Its incidence has been rising over the past several years, making it a major public health concern. It is also among the most commonly diagnosed cancers globally,” says Dr Atul Batra, Professor in the Department of Oncology at AIIMS.
Why women may be diagnosed late
In India, breast cancer has displaced cervical cancer as the most diagnosed malignancy among women. According to a 2020 study in Lancet Regional Health South Asia, it accounted for 13.5% of all newly diagnosed cancer patients and approximately one-tenth of cancer-related deaths nationwide. The study showed substantial regional variation, metropolitan cities reporting higher incidence than semi-urban and rural regions, where incidence has been rising steadily.
Unlike many high-income countries where organised screening programmes and greater awareness facilitate early detection, a considerable proportion of Indian women continue to present with advanced-stage or metastatic disease at diagnosis significantly affecting treatment options and outcomes.
“In India, approximately 30% of patients present with early-stage disease, around 60% with locally advanced disease and about 10% with metastatic disease at the time of diagnosis. In other words, six out of 10 patients present with locally advanced breast cancer, which may involve a large tumour or lymph nodes,” Dr Batra says.
“In many developed countries, around 60–70% of patients are diagnosed at an early stage. This difference highlights the extent of delayed diagnosis in India. Moreover, some patients initially diagnosed at an earlier stage may later develop metastatic disease,” he adds.
Doctors say the lump may initially be painless. Some women may delay seeking medical attention because they do not recognise it as a warning sign, fear a cancer diagnosis, or face stigma and monetary limitations. Others may encounter delays in referral, imaging, biopsy, or access to a specialist.
These barriers, according to experts, can be particularly difficult for women living far from cancer centres, where diagnostic services and specialist care may require considerable travel. Out-of-pocket expenses, time away from work, and family responsibilities can further complicate access.
A growing burden, with concerns about younger women
Breast cancer is often associated with older women; the truth is it can also occur in younger women. Indian clinicians have raised concerns about patients presenting at relatively young ages, although the age distribution varies across populations and studies.
“The perception that cancer is a disease of old age no longer holds in India. While breast cancer in the West has traditionally been seen in women in their 60s and 70s, in India, it tends to occur about a decade earlier, around the age of 50. Increasingly, however, we are seeing cases among women in their 30s and even their 20s,” says Dr VK Bansal, Professor of Surgery at AIIMS.
A 2025 review published in JCO Global Oncology, highlights the country's substantial disease burden and concerns about younger patients. It cited the GLOBOCAN estimates and projected that India's annual cases could rise to approximately 519,507 by 2050.
Doctors say breast cancer risk is affected by various factors. Dr Chadha says risk increases with older age at marriage and pregnancy, inherited genetic changes such as BRCA1 and BRCA2 mutations, family history, reproductive and endocrine factors like early menarche and late menopause, alcohol consumption, and excess body fat after menopause. Many women who develop breast cancer, however, have no known family history or a single identifiable cause.
Screening: Awareness alone is not enough
A Tata Memorial Hospital-based study found 54% of patients had late-stage disease.
What late diagnosis costs. One study in the World Journal of Clinical Oncology (2022) reported five-year survival of 95% for stage I, 92% for stage II, 70% for stage III, and only 21% for stage IV.
Experts say screening aims to detect cancer before symptoms appear, whereas diagnostic evaluation investigates a symptom or an abnormal finding. “The distinction matters and so does the outcome; that's why there is an unmet need for screening and early diagnosis,” says Dr Dodul Mondal, principal director and head of radio-oncology at Max Hospital Saket.
India's national non-communicable disease programme includes population-based screening and referral for common cancers like breast cancer, through the public healthcare system for people aged 30 and above.
However, having a policy does not necessarily mean every eligible woman is screened, receives follow-up testing, or completes treatment. “We do not yet have a nationwide, organised mammography-based breast cancer screening programme. Screening in India is largely opportunistic. A woman visiting a hospital for another reason may be advised to undergo screening, particularly if she is in the relevant age group. However, this depends on whether the facility has the necessary equipment and services,” says Dr Batra.
In many countries, screening is generally recommended from age 40–45 to 70–75, with mammography annually or every two years. Women with a strong family history or certain inherited genetic mutations may need much earlier, sometimes around age 25.
In India, women do not routinely receive mammography invitations through a national screening system, and primary healthcare settings offer limited access. NFHS-5 found only 0.9% of women had ever had a breast examination for cancer detection and only about 1% of women 45 and older reported mammography, highest in Kerala and lowest in Nagaland.
In such scenario, experts also say breast self-awareness is important. “Women should stand in front of a mirror from age 20 onwards and observe their breasts and know what is normal for them. They should seek medical assessment for a new lump, changes in breast shape or skin like orange peel, nipple inversion, unusual nipple discharge, or a lump in the armpit. These signs do not necessarily mean cancer, but they should not be ignored,” Dr Chadha explains.
Breast self-examination should not replace evidence-based screening or clinical evaluation. Women with symptoms should not be told to wait until their next screening appointment.
Treatment is changing, but access matters.
Breast cancer is not one disease with one treatment. Care depends on the tumour's stage and biological characteristics, including hormone-receptor and HER2 status.
Treatment may involve surgery, radiotherapy, chemotherapy, hormone therapy, targeted medicines or, in selected cases, immunotherapy. An advanced disease may require more prolonged treatment tailored to the cancer's biology and response.
“Advances in pathology, molecular testing and targeted treatment have expanded options for some patients. But access to these services, their cost and the ability to complete treatment remain important questions in India,” says Dr Sameer Kaul, senior oncologist at Indraprastha Apollo, New Delhi.
A diagnosis can involve multiple expenses beyond medicines, including imaging, biopsies, surgery, travel, accommodation, and lost income. “For families without adequate financial protection, these costs can affect treatment decisions and continuity of care,” Dr Kaul adds.
Moving from awareness to action
India's breast cancer challenge cannot be addressed through a single intervention. Risk reduction, early recognition, timely diagnosis, and appropriate treatment all matter, as does research into regional and age-group differences in disease patterns.
For women, the practical message is to seek medical attention whenever in doubt; for policymakers, the priority is to ensure screening and referral programmes reach the women who need them, diagnosis is timely, and patients can access and complete treatment.
The goal should be that women have access to appropriate care and survive the disease.