Does better screening explain Kerala’s high cancer numbers? Experts weigh in

Kerala, often praised for its public health systems and touted for its performance on development indices, has topped another metric— it has emerged as the state with the highest per capita cancer incidence in India, according to recent government data.

A reply in the Lok Sabha by Minister of State for Health and Family Welfare Prataprao Jadhav on December 5, 2025, revealed that while the country, on average, saw 110 cancer cases per lakh population in 2024, the same figures for Kerala were significantly higher at 170. 

While the 'Kerala Model' is often cited as an example and the state's performance during the pandemics and other disease outbreaks are praised, experts claim that in fact this increased access to healthcare, coupled with higher awareness among the public and better screening practices, could be behind the higher numbers.

However, they also flag the lifestyle choices, diets, and high tobacco and alcohol consumption also as possible risk factors driving the increased cancer incidence in the state.  

What is the prevalence of cancer in India? 

The parliament response shows that there were over 15 lakh cancer cases reported in the country in 2024, which is about 10 per cent more than the 14 lakh cases reported in 2020. The highest number of cancer cases, in absolute terms, was reported in Uttar Pradesh, with about 2.2 lakh cases in 2024. Maharashtra, with close to 1.3 lakh cases, came a distant second, followed by West Bengal with about 1.2 lakh cases. However, these high numbers could be a function of the states' high populations as well—the higher the number of total people in the state, the higher the number of cancer cases reported.

This is why we look at the incidence rate of cancer as well, to get a clearer picture. While the national average in 2024 stood at about 110 cancer cases per lakh population, Uttar Pradesh had a much lower incidence rate—at about 93 cases per lakh population. Kerala, with over 170 cases per lakh population, and Mizoram, with 169 per lakh population, reported the highest per capita cancer rates, followed by Andhra Pradesh (144), Karnataka (139), and Telangana (137).  

Some of the lowest incidence rates were recorded in states and UTs such as Lakshadweep, which saw an incidence rate of less than 50.  

What’s driving Kerala’s high cancer incidence? 

As per the Lok Sabha reply, Kerala recorded 61,175 estimated new cancer cases in 2024. More significantly, Kerala’s per capita incidence stands at 170 cases per lakh population, the highest in the country. 

One of the earliest insights into Kerala’s cancer profile comes from a classical case-control study from the early 90s, titled ‘Risk factors for cancer of the oesophagus in Kerala, India.’ Conducted in Thiruvananthapuram, the study analysed 267 oesophageal cancer patients and 895 controls, assessing lifestyle habits such as pan (betel)-tobacco chewing, bidi and cigarette smoking, snuff use, and alcohol consumption.  

In men, the researchers found strong associations between oesophageal cancer and bidi smoking, combined bidi-cigarette use, and alcohol intake. The study reported that bidi smoking for more than 20 years carried a relative risk of 4.70, while consuming more than 20 bidis/cigarettes per day carried a risk of 4.80. A pan-tobacco habit of more than 40 years was associated with a relative risk of 2.03, and regular alcohol use carried a risk of 2.33, after adjusting for confounders. Interestingly, among women, pan-tobacco chewing did not show a significant effect. This early research highlights how Kerala’s long-standing prevalence of smoking, especially bidi use, and alcohol consumption contributed historically to higher cancer susceptibility in the region. 

Two decades later, a 2020 study from Kerala’s Pathanamthitta district added another layer to this picture. Conducted in Niranam Panchayat using a door-to-door survey covering 13,736 people, the study found a diagnosed cancer prevalence of 652 per 100,000 population, significantly higher than older state-level estimates. Breast cancer emerged as the most common type, accounting for 37.3 per cent of identified cases. The researchers noted that warning signs such as breast lumps were widespread, with a prevalence of 400 per 100,000. According to the study, “increasing age, female gender and occupational status were the factors found to be significantly associated with cancer.” 

Although the study also cautioned that, as they “had to cover a large population, only selected risk factors were studied. The data lacked specificity as the data was not collected by medical professionals but by trained ASHA workers/field workers. Data on period prevalence and mortality were not assessed, as only point prevalence was taken. The data on warning signs was based on self-report and not by clinical examination. Even though the prevalence of cancer was high the number of cancer cases was small to study statistical significance in a subanalysis.” 

More insight into Kerala’s rising cancer burden comes from a statewide awareness and screening survey conducted by the Association of Medical and Pediatric Oncologists of Kerala (AMPOK) between October and December 2024. Using a mixed-method approach that combined online questionnaires with door-to-door surveys, the study assessed public awareness of cancer risk factors, prevention strategies and screening practices.

The survey found that Kerala’s increasing cancer burden is being driven by demographic transition and unhealthy lifestyle patterns. Participants showed relatively high awareness of cancer symptoms and common risk factors, with most correctly identifying tobacco use, alcohol consumption, poor diet and physical inactivity as major contributors. The study also flagged concern over the influence of cinema actors and sportspersons in normalising tobacco use among youth, highlighting the role of cultural icons in shaping health behaviours. 

Despite this awareness, AMPOK noted that preventive action remains weak. Knowledge about cancer prevention strategies, such as human papillomavirus vaccination and genetic testing, was limited, and screening rates were reported to be alarmingly low. The authors noted that “despite heightened awareness, screening rates remained low,” underscoring a major gap in early detection. 

The survey also revealed persistent misconceptions and stigma. Some respondents believed mobile phone use causes cancer or that all pesticides are harmful, even at safe levels, pointing to the need for targeted myth-busting campaigns. A significant proportion of participants expressed fear about the financial burden associated with cancer treatment, while stigma around diagnosis and treatment remained widespread. 

Comparing its findings with a 2020 American Society of Clinical Oncology (ASCO) survey, AMPOK reported higher risk perception in Kerala. “Awareness of cancer risk was higher among AMPOK respondents,” with 84 per cent expressing concern about lifetime cancer risk. However, the study stressed that awareness alone has not translated into preventive behaviour, particularly routine screening. 

The authors concluded that while Kerala benefits from high literacy and relatively strong awareness, rising cancer cases are linked to lifestyle risks, misinformation, stigma, low screening uptake and lack of a systematic screening programme. They emphasised the need for context-specific education campaigns, affordable screening services and early detection strategies, noting that lessons from Kerala could inform cancer control efforts in other regions facing a similar rise in cancer burden.

Are better screening practices behind the high incidence rates?

Adding to this line of evidence, Dr Jayaprakash Muliyil, India’s top epidemiologist and former Principal of Christian Medical College, Vellore, urged caution in interpreting Kerala’s rising cancer numbers in isolation.

According to Dr Muliyil, one key reason behind higher reported cancer cases is better and more widespread screening. As health systems become more efficient, cancers are detected earlier and in greater numbers. “Screening means you are actively looking for diseases like breast or prostate cancer,” he explained, adding that improved detection naturally leads to more diagnoses, even if mortality does not change. 

He introduced the concept of “lead-time bias,” noting that many cancers, such as certain prostate and breast cancers, are slow-growing. “You diagnose them earlier and sometimes treat them unnecessarily, but the net mortality may not change,” he said. What does increase, however, is “the time a person lives with the label of being a cancer patient.” 

Dr Muliyil stressed that Kerala’s situation is different from less-developed states. With higher literacy, better female-to-male ratios, and stronger public and private healthcare systems, cancers are being detected earlier and in younger age groups. “It may look like cancer cases are rising rapidly, but in many places outside Kerala, cases are simply being missed,” he said. 

On causes, he urged caution. Drawing from decades of epidemiological work, he said, “Our success rate in finding exact causes of cancer is extremely low.” While tobacco smoking is clearly linked to lung cancer and tobacco chewing to oral cancer, many other commonly blamed factors, such as meat consumption or sedentary lifestyles, often show association, not causation. “Association does not mean causality,” he underlined. 

He added that age remains the strongest and most consistent risk factor. Cancer, he explained, results from errors in DNA transcription that accumulate over time. “As you grow older, the body’s ability to correct these errors reduces,” making ageing populations naturally more cancer-prone. 

On screening campaigns, Dr Muliyil supported early detection but cautioned against large-scale, target-driven programmes. He pointed out that “such campaigns often become number-centric, where meeting screening targets can take precedence over individual patient needs.” He also flagged the risks of false positives and the psychological distress they can cause, arguing that “screening should be accompanied by continuous patient education, psychological counselling, careful medical oversight, and ethical decision-making to ensure patients are supported at every stage.” 

Steps taken by the Kerala government

Earlier this year, Kerala Health Minister Veena George announced that the state had begun a year-long campaign on February 4, observed globally as World Cancer Day, to promote better and faster detection of cancer. The initiative has been formally titled ‘Aarogyam Anandam: Akattaam Arbudam.’

Targeting women above 30, it focuses on breast and cervical cancer, addressing late diagnoses caused by stigma, fear, and financial concerns. Screening—via clinical breast exams, Pap smears, and VIA/VILI tests—is available at PHCs, FHCs, CHCs, and hospitals, with abnormal cases referred for further evaluation and treatment. 

The programme involves community mobilisation through panchayat workers, Kudumbashree groups, NGOs, and women’s groups, with patient navigators supporting diagnostics and treatment adherence. Free screening and treatment are ensured for vulnerable families, while data is tracked through the Shaili app and cancer care portal. The intensive phase ran from February 4 to March 8, 2025, with plans to expand coverage throughout the year, gradually including more cancers and men. 

Dr Bipin Gopal, State Nodal Officer (NCD), Government of Kerala, highlighted the state’s proactive approach to cancer prevention and early detection. According to him, one of the main factors contributing to Kerala’s high cancer incidence is the increasing life expectancy of its population, with men living up to 73 years and women up to 80 years on average. “As age increases, the likelihood of developing cancer also rises,” he said. 

He also pointed out lifestyle factors contributing to specific cancers. “Colorectal cancers are largely attributed to dietary habits, high consumption of oils, and other unhealthy practices,” he explained. Regarding oral and lung cancers, Dr Gopal noted, “Smoking was very prevalent in Kerala in the past, which explains the higher cases of lung and oral cancers. Although smoking rates have reduced from 21% to 12%, the older population still accounts for these cases. However, alcohol consumption has risen, with 35% of adult males drinking regularly.” 

On the state’s screening efforts, Dr Gopal emphasised the importance of early detection. “Cervical and breast cancer awareness among women is high, and they actively participate in screenings. Screening has been decentralised down to the panchayat and PHC level, and suspected cases are referred to secondary hospitals for confirmation.” He noted that this approach helps detect more cases and ensures timely treatment, setting Kerala apart from many other states. 

Dr Gopal also highlighted the government’s recent awareness campaign. “The Arogyam Aanandam campaign aims to bring screening to the community for early detection at a pre-cancerous stage,” he said. He described how the campaign engaged women’s organisations, self-help groups, and community networks to overcome stigma and fear associated with cancer screening. 

“Since the launch on World Cancer Day, February 4, 2025, over 20 lakh people have been screened,” Dr Gopal revealed. “Interestingly, more than 300 new breast cancer cases were detected at very early stages, over 100 pre-cancerous breast cases, 70–80 new cervical cancer cases, and over 200 pre-cancerous cervical cases. Early detection allows us to prevent these cases from progressing into active cancer.” 

He concluded by emphasising the combined role of government readiness and public awareness. “The system is prepared, and the people are aware of the disease. This ensures they report for screening at the earliest, making prevention and early treatment possible.” 

This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.