Time to Act: Addressing India's Head and Neck Cancer Screening Crisis

Abstract Head and neck cancers (HNCs) are a significant public health concern in India, with 60 to 90% diagnosed at advanced stages, resulting in poor survival outcomes. Early detection improves prognosis substantially, with survival exceeding 80% in early-stage disease but dropping below 40% for late-stage cases. Despite evidence supporting screening benefits, India lacks a structured nationwide program for HNCs, and current efforts are fragmented. National initiatives such as the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), Ayushman Bharat, and various state efforts involve community health worker training and mobile screening units. Digital health tools and tele-oncology systems, like ONCONET and mobile health (mHealth) platforms, show promise in enhancing access to screening, especially in underserved populations. However, participation remains extremely low, with the National Family Health Survey-5 (NFHS-5) reporting oral cancer screening coverage below 1% nationally and significant inter-state variability. Visual inspection and toluidine blue staining remain common due to affordability and ease of use. Advanced technologies such as artificial intelligence (AI)-assisted diagnostics, liquid biopsy, and salivary biomarkers are emerging but not yet widely implemented. Major barriers include poor awareness, stigma, tobacco use, socioeconomic factors, insufficient insurance coverage, and infrastructural and workforce limitations. Public-private collaborations and nonprofit initiatives have made progress, but require coordination and integration within national programs. To effectively reduce morbidity and mortality, India needs a comprehensive, multi-sectoral strategy integrating AI tools, expanding frontline health worker roles, enhancing education, improving affordability, and establishing systematic monitoring and follow-up mechanisms. With robust implementation, India can improve early detection rates, reduce disparities, and effectively address the rising burden of HNCs.