INTEGRATION OF PREVENTIVE ONCOLOGY SERVICES INTO INDIA'S PRIMARY HEALTHCARE SYSTEM: A REVIEW OF MODELS, EVIDENCE, AND GAPS

Abstract

Background: Cancer is now among the leading causes of premature mortality in India, with cervical, breast, and oral cancers together accounting for a substantial share of the national burden [1,2]. Because most cancer deaths in India occur at advanced, largely unpreventable stages, global and national bodies have called for early detection and prevention to be delivered as close to the community as possible, through the primary healthcare system [3,4]. Methodology: A narrative review with a structured, PRISMA-style literature selection process was conducted, searching PubMed, Scopus, Embase, Google Scholar, and grey literature from the Ministry of Health and Family Welfare (MoHFW) and World Health Organization (WHO) for records on preventive oncology integration into Indian primary care published up to 2026. Of 210 records identified, 28 studies, program reports, and policy documents met the eligibility criteria and were retained for synthesis. Observations: Two major national policy platforms—the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and the Ayushman Bharat Health and Wellness Centre (HWC) initiative—now provide the structural backbone for population-based screening of oral, breast, and cervical cancers at the primary-care level. Landmark cluster-randomised trials conducted in Kerala, Mumbai, and rural India demonstrated that community health worker-led visual and HPV-based screening can meaningfully reduce cancer-specific mortality. However, translation of this trial-generated evidence into routine primary care delivery remains uneven, constrained by workforce shortages, weak referral linkages to diagnostic and treatment centres, inconsistent screening coverage across states, and limited follow-up of screen-positive individuals. Conclusions: India's primary healthcare system now possesses a credible policy and infrastructural foundation for preventive oncology, but realising its population-level impact will require strengthening referral pathways, expanding and retaining a trained frontline workforce, and building robust data systems to track individuals from screening through to treatment completion.