From Late Diagnosis to Early Action: What Kerala Can Teach India About Breast Cancer Screening

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Breast cancer is one of the most commonly diagnosed cancers among Indian women. Despite growing cancer awareness and multiple advances in medical care, a puzzling pattern persists - late diagnosis. In India, it has been increasingly noticed that most women are diagnosed only when the disease has progressed to advanced stages.

Late diagnosis is not merely a clinical issue but a major public health concern. Kerala demonstrates that strategic, prevention-led approaches can drive transformative improvement in early detection and outcomes. Its experience provides actionable guidance for the rest of India to replicate. We spoke to Dr Reenaa Mithun Chittilappilly, Director, V-Guard Foundation, who shared insights on the same.

Where Kerala stands

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"Kerala's healthcare success is rooted in prevention-led practices and approaches. Its strong primary healthcare systems, community engagement, and relatively higher health literacy have helped in this process. Initiatives, such as clinical breast examinations, routine check-ups, and awareness initiatives, are increasingly integrated into one's life," said Dr Reenaa.

Implementing a change from immediate treatment of disease symptoms to an emphasis on reducing or eliminating the development of disease is how breakthroughs in this area have occurred. Through this transformation, we have seen significant improvements in early detection rates of patients with breast cancer.

The real question is, was this change achieved by primary healthcare systems alone? No! "Equally important in this process is the role of grassroots healthcare workers. ASHA workers, nurses, and frontline staffs that act as trusted messengers, educating women about self-examination, recognising early warning signs, and guiding them to screening facilities. By delivering health content through known pathways within the community, health messages become easier to access, relatable, and actions can then be taken to intervene," added Dr Reenaa.

The Indian Context

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In many parts of India, apart from Kerala, a symptom-driven approach is practised to detect breast cancer. This is because the majority of screening centres remain in urban areas, while rural and semi-urban populations face limited access. In addition, cultural stigma surrounding breast health further delays diagnosis, and the absence of a structured screening programme continues to widen disparities.

"On the other hand, Kerala demonstrates that screening must be ingrained into routine healthcare just like diabetes, hypertension, and maternal care, rather than treated as a specialised service accessed only when illness becomes visible, thus promoting early detection. But early detection is not achieved through campaigns alone; it requires consistent efforts, availability, follow-up mechanisms, and community trust," added Dr Reenaa.

Notable initiatives like the Cancer Shield Project have helped in bringing breast cancer awareness and prevention in Kottayam and Ernakulam districts, associated with the Kerala Police Association and Janamaithiri Police. The initiative was aimed at providing free screening services (ultrasound and mammogram). Such initiatives and projects illustrate the truth in collaborative, horizontally-organised, patient-centred preventive health; women should be supported to navigate care pathways after their initial screening so they do not slip through the cracks.

The Future Roadmap

Even Kerala continues to have difficulties with access to mammograms for women living in rural areas; however, it has created a robust prevention framework that has the potential to serve as a model for other parts of India where screening issues and stigmas still exist.

Dr Reenaa concluded, "Steps must now be taken to shift from raising awareness of breast cancer to providing access to mammograms for all women, which will require empowering the primary healthcare workforce to identify women who require breast cancer screening. Above all, improving early detection rates for breast cancer requires cultural change and community ownership."

"Kerala's experience shows late discovery is not only a health issue but a policy and societal choice. To effectively reduce late breast cancer diagnosis across India, we must adopt Kerala's strategies, ensuring all women have equitable access to early screening and timely diagnosis regardless of location or status," added Dr Reenaa.

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.