Don’t overlook cancer among children
India’s paediatric cancer burden, underscored by the latest findings from the Global Burden of Disease (GBD) 2023 study published in Lancet Oncology, reveals a landscape marked by persistent gaps. Cancer is now the tenth leading cause of death among children, with an estimated 17,000 deaths in 2023, even as global mortality has steadily declined. Studies estimate that there are roughly between 50,000 and 75,000 new paediatric cancer cases each year in India, though the true figure may be higher –cancer registries cover barely 10–15 per cent of the population. Set against the global picture — low- and middle-income countries account for the overwhelming majority of childhood cancer deaths — India’s experience reflects both its demographic weight and its uneven health infrastructure. Many childhood cancers are among the most treatable of malignancies, yet survival outcomes continue to remain uneven.
Paediatric cancer occupies a nebulous place in public health priorities. India’s core national cancer-control priorities focus largely on adult variants. This omission is compounded by weak surveillance systems and significant underdiagnosis. Primary care systems are not uniformly equipped to recognise early warning signs, and specialist services remain concentrated in urban centres, leading to delayed diagnosis, referrals and treatment. Inequalities, especially financial and logistical, continue to shape outcomes. As a result, many children are brought in when the disease has already progressed to an advanced stage; a sizeable section discontinues treatment before completion.
Yet, the evidence also points, rather cautiously, towards possibilities. Where timely diagnosis and uninterrupted treatment are available, survival rates, especially for cancers such as leukaemia, have improved significantly. This suggests that India’s childhood cancer burden is not intractable. The next phase must focus on scaling up — embedding paediatric oncology in national cancer-control strategies, expanding decentralised treatment capacity, training frontline providers to recognise early signs, and building robust data systems, alongside research into genetic and environmental determinants. India’s alignment with global efforts, including WHO’s childhood cancer initiative, offers a guiding framework. Policy must now focus on translating incremental gains into equitable outcomes.
- 1India's national cancer-control strategies reveal a significant governance gap by primarily focusing on adult cancers, overlooking the rising paediatric burden. This policy omission results in weak surveillance systems and under-equipped primary healthcare, failing to ensure early diagnosis for children. Addressing this requires embedding paediatric oncology into national health priorities and decentralising specialised treatment centres to improve accessibility and outcomes across the country.
- 2India's response to paediatric cancer is framed by international cooperation, notably through alignment with the World Health Organization's (WHO) Global Initiative for Childhood Cancer. Data from global studies like the GBD 2023, published in Lancet Oncology, highlights India's significant contribution to the global childhood cancer burden. This underscores the need for India to adopt global best practices and frameworks to improve its domestic health outcomes.
- 3The state's failure to adequately address paediatric cancer raises constitutional concerns under Article 21, which guarantees the Right to Life, interpreted by the Supreme Court to include the Right to Health. Furthermore, it reflects a lapse in fulfilling Directive Principles, specifically Article 47, which mandates the state to improve public health. This gap between constitutional promise and public health delivery could be a basis for future litigation.
- 4The economic and social impact of paediatric cancer in India is marked by deep inequalities, where financial and logistical barriers significantly hinder access to care. This disparity forces many families, particularly in rural areas, to delay diagnosis or discontinue treatment, worsening survival outcomes. The concentration of specialist services in urban centres exacerbates this divide, highlighting the urgent need for equitable and affordable public health interventions.