Breast Cancer Awareness Month: What we owe to our women?

We observe Breast Cancer Awareness Month, or Pink Month, in October. Our mission is to ensure that no woman in Kerala misses the early warning signs of breast cancer; no case of early breast cancer goes undetected or untreated; and no woman presents with late-stage breast cancer in any of our health-care institutions.

In 2024, approximately 24 lakh new breast cancer cases were diagnosed globally, and about 6.94 lakh deaths were reported, as per the World Health Organization’s GLOBOCAN data. While breast cancer is the commonest cancer in women globally, accounting for a quarter of cancers reported in women, it is the second most common cancer, accounting for 11.8% of all cancers. With regard to cancer mortality, breast cancer ranks the fourth highest.

What is alarming is that in India, the commonest cancer today is breast cancer, accounting for 15.2% of all cancers, ahead of cancer of the lip and oral cavity (13.2%) and cancer of the lung (7.2%). In women, breast cancer is the commonest (30.4%), ahead of cancer of the uterine cervix, which accounts for just 7.2 % of cancers (WHO Globocan 2024 data).

More alarming is the fact that while the 5-year survival rate for breast cancer exceeds 90% in Western countries, the 5-year survival rate in India is only around 65% to 70%. This is attributable more to delayed presentation of cases, with more than 60% of cases presenting at later or advanced stages.

The incidence of breast cancer in Kerala also presents a similar picture, with an incidence of 17.5 % among all cancers in the entire population and 34.4 % among all cancers in women, as per the cancer burden profile compiled by the Indian Council for Medical Research and the National Institute for NCD Epidemiology (ICMR-NINE) in 2026. The high incidence can be attributed to our high life expectancy and the health-seeking behaviour of our population. Analysis of the RCC data for the 2015-2018 period shows a 5-year survival probability of 98.2% in Stage I and 96.8% in Stage II, declining to 88.6% in Stage III and further to 67.3% in Stage IV, which clearly points to the requirement for early detection and treatment.

Epidemiological studies trace the aetiology of breast cancer mostly to non-modifiable risk factors like genetic mutations, prolonged oestrogen exposure on account of early menarche and late menopause and a positive family history of breast cancer in first-degree relatives. The causal effect of modifiable risk factors like obesity and long-term hormone replacement therapy has not been conclusively established in most cases; nevertheless, those women who are genetically predisposed to breast cancer need to be guarded against these risk factors.

The road map of the Kerala Health Department has clear and specific action points: Dissemination of information about early warning signs; early identification of cases; and management of those who have breast cancer as per standard treatment protocols. Screening, early diagnosis and timely management are our key priorities. The futuristic cancer treatment strategy announced in the hundred-day programme of the government also has these targets as key guiding principles.

The gold standard therefore is screening. The Kerala strategy advocates a three-pronged framework for screening: self-breast examination for women in the twenty-plus age group; clinical breast examination by trained health-care workers and health professionals for women in the thirty-plus age group; and mammographic screening in the forty-plus age group.

Our tertiary health care facilities (Medical College Hospitals) and some secondary Health care facilities (almost all District and General Hospitals and some Taluk-level hospitals) have facilities for mammography and even digital mammography. The treatment protocols have been developed by our health system in accordance with standard international guidelines and in consultation with the quaternary cancer care centres- the Regional Cancer Centre Trivandrum, the Malabar Cancer Centre and the Cochin Cancer Care Centre.

The government is committed to ensuring that breast cancer management is affordable for all patients accessing the government health-care facilities. We have state-of-the-art radiotherapy units in the quaternary cancer centres and the old Medical Colleges, and in hospitals like the General Hospital Ernakulam and the Nalloornad Tribal Hospital in Wayanad. Chemotherapy facilities have been established in 28 District and taluk-level hospitals in addition to the facilities in the major centres.

Robotic surgery units are functional at RCC and MCC; and the process is underway for procurement of a robotic surgery unit at the Trivandrum Medical College. The Oommen Chandy Health Insurance policy announced in the budget, when implemented, will have adequate coverage to cater to patients with late-stage cancers too. The contours of the scheme and packages for coverage of catastrophic health conditions are being worked out. The existing Ayushman Bharat Insurance Scheme coupled with the Karunya Arogya Suraksha Padhathi which is presently under implementation provides coverage up to ₹5 lakhs per annum for eligible families.

Fixation of prices of anticancer medicines falls outside the realm of the state Health Department. The state government, nevertheless, through the Kerala State Medical Services Corporation Limited procures anticancer medicines for the Medical Colleges and the other hospitals, and also procures equipment for diagnostic and therapeutic interventions. The National Pharmaceutical Pricing Authority (NPPA), the drug price regulator, has regulated the ceiling prices of 63 anti-cancer drugs, which are listed in the National List of Essential Medicines 2022 (NLEM 2022). All manufacturers have to sell their products within the ceiling price (plus applicable Goods and Services Tax) fixed by NPPA. In addition, NPPA has fixed retail prices of 58 anti-cancer drugs, which are non-scheduled formulations and hence do not come under the ceiling price cover of the NLEM.

Further, through a landmark notification of 17th October 2026, NPPA undertook an exercise of Trade Margin Rationalisation (TMR) of 137 identified non-scheduled anti-cancer drugs, in exercise of its powers under Para 19 of Drugs Prices Control Order 2013 (DPCO, 2013). It is reported that when the revised rates become effective from November 9, 2026, the MRP of the identified non-scheduled anti-cancer drugs will be reduced by up to 70%, depending on their existing price structures.

The judiciary is also alert to the alarming rise in the prices of anticancer medicines. The Supreme Court of India in WP © No.794/2023 [Kishan Chand Jain vs Ethics and Medical Registration Board of India and another], tagged with WP © 717/2026 [Dr Sanjay Kulshetra vs Union of India], has highlighted the intent of the Court to strengthen governmental efforts to regulate prices. The apex court has directed the central government to work out the modalities for capping medicine prices (medicines other than anti-cancer medicines too) and has posted the matter for further hearing on October 27, 2026.

The High Court of Kerala, in its judgment delivered on 28th September 2026 in WP © 18999/ 2022 in [Re Exorbitant pricing of life-saving patented medicines vs Union of India and others], directed the central government to consider invoking Section 100 of the Patent Acts’, 1970 to bring the patented anti-breast cancer medicine ‘Ribociclib’ under compulsory licence, so that the medicine is affordable for patients who are prescribed the medicine.

A patient diagnosed with cancer cannot afford to bear the double burden of the crippling disease and unsustainable prices of medicines and the treatment regimens. Cancer patients need care and compassion to withstand the emotional and physical trauma due to the disease, and adequate support in monetary terms to meet the cost of management of their disease. Policymakers, regulators and the judiciary are adequately sensitised to the fact that unaffordable treatment regimens without measurable therapeutic outcomes are unacceptable to the public.

The Health Department therefore is entrusted with the responsibility of ensuring that patients with cancers like cancer breast do not progress to advanced stages of the disease, when the treatment outcomes may not turn out to be as desirable as compared to treatment in early stages. Ensuring that every woman undergoes screening – at least a clinical breast examination from the third decade and an annual mammography from the fourth decade for those who are potentially at high risk– is not a tall order for our state.

The health system in Kerala is adequately geared to achieving this objective, with our robust cancer-grid and our hub-and-spoke health system model. Observation of the Pink Month or the Breast Cancer Awareness Month would become meaningless unless the triple-A strategy of availability, accessibility and affordability – for breast cancer screening, detection and management facilities is assured and ensured for all the girls and women of our state. This is the minimum that we owe to our women. The Kerala Health Department is working in that direction.

(The author is Principal Secretary, Health Department, Government of Kerala.)