A new study has spotlighted serious gaps in cancer screening and awareness efforts in Meghalaya, despite the northeastern state reporting a substantial share of India’s cancer burden. Researchers have found that cancer prevention activities remain fragmented, under-resourced, and consistently overshadowed by other non-communicable diseases (NCDs), such as diabetes and hypertension, under the Centre’s flagship National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).
The qualitative study, “Barriers in implementing cancer prevention programme in North Eastern India: A case study from Meghalaya,” published in the latest edition of the Indian Journal of Medical Research (IJMR), examines how delayed rollout, systemic gaps, and uneven prioritization have weakened cancer prevention efforts in the state.
According to experts, Meghalaya is grappling with one of the highest cancer rates in India, particularly for mouth and esophagus cancer, with a staggering 176 cancer cases per one lakh population.
Testimonies from healthcare providers and frontline workers reveal that although the NPCDCS mandates equal focus on cancer, diabetes, hypertension, and stroke, cancer prevention continues to take a back seat—underscored by shortages of basic supplies such as acetic acid for cervical cancer screening, limited training, poor awareness, and weak referral and follow-up mechanisms.
“We are expected to screen women for cervical cancer using visual inspection with acetic acid, but the acetic acid itself is not available,” a healthcare provider at a community health centre (CHC) in Meghalaya is quoted in the study saying. Another frontline worker pointed to the skewed focus of non-communicable disease services: “For diabetes and blood pressure, awareness activities happen regularly. But for cancer, I do not remember anyone coming to give awareness sessions.”
Moreover, much of the IEC content is in English, limiting its reach in tribal and rural communities. “For cancer, the IEC content mainly focuses on oral cancer. We are yet to develop material for breast and cervical cancer,” a state programme administrator admitted to the researchers.
The study, conducted in East Khasi Hills and East Jaiñtia Hills districts, involved 56 participants, including programme administrators, medical officers, staff nurses, counselors, community health officers, and frontline workers such as ASHAs and ANMs.
Programme administrators acknowledged that while hypertension and diabetes services were rolled out from 2015–16, cancer screening activities began only in 2018–19 and were further disrupted by the COVID-19 pandemic, noted researchers Fellicita Pohsnem, Melari Shisha Nongrum', Rajiv Sarkar, and Sandra Albert from the Indian Institute for Public Health Shillong, Meghalaya.
At the facility level, this imbalance is evident. Healthcare providers reported that population-based screening for oral, breast, and cervical cancers is expected at CHCs, primary health centres, and health and wellness centres. However, in practice, screening is largely limited to oral and breast examinations. Cervical cancer screening using visual inspection with acetic acid (VIA) is rarely conducted because acetic acid—a basic, low-cost consumable—is often unavailable.
Low community awareness emerged as another critical barrier. Healthcare providers and frontline workers reported that most information, education, and communication (IEC) materials focus on oral cancer, with little emphasis on breast or cervical cancers.
As a result, acceptance of screening—especially for breast and cervical cancers—remains low, particularly in rural areas. Frontline workers reported that many women hesitate to disclose symptoms such as abnormal vaginal discharge due to embarrassment or fear. “Some women refuse to share information and feel shy talking about unusual discharge,” said a frontline worker from East Jaiñtia Hills, as per the study.
The study highlighted significant gaps in training and staffing. While the NPCDCS aims to build capacity through regular training programmes, many healthcare workers—especially in East Jaiñtia Hills—reported delays due to the pandemic. Some frontline workers could not recall receiving any recent cancer-related training.
Inadequate infrastructure also affects screening uptake. Many providers cited the lack of privacy at health camps as a deterrent, particularly for breast and cervical examinations. Screening rates were reported to be higher in urban areas, where awareness and willingness to participate are greater.
Providers also noted a strong preference for traditional healers, especially in remote areas where traditional medicine is accessible, affordable, and culturally accepted. Fatalistic beliefs that cancer is incurable also discourage timely treatment.
Even when patients are referred to tertiary facilities—often located in Shillong, up to 87 km away—follow-up remains poor. High out-of-pocket costs for diagnosis, treatment, and travel lead many patients to abandon care. It may, however, be noted that part of the data was collected during the COVID-19 pandemic, when health systems were functioning sub-optimally as resources were redirected to pandemic-related issues. Since then, some of the concerns raised in the study have begun to be addressed, indicating progress.
When asked to comment on the study’s observations, Jyotsna Govil, Chairperson of the Indian Cancer Society (ICS), Delhi Branch, at an event held in the national capital on the eve of Cancer Awareness Day, said that while she was yet to examine the study in detail, there was no doubt that early detection and prevention must take center stage alongside the expansion of treatment services.
Giving the nationwide perspective of the status of the cancer cases, which are set to spike to over 2.45 million by 2045 from the current 1.5 million annually, she pointed out that screening has remained extremely low while survivors are left to fend on their own as they remain uninsured and unsupported.
While welcoming the recent Union Budget announcement proposing a waiver of customs duty on select cancer drugs, Govil cautioned that lowering drug costs alone would not be enough to address India’s growing cancer burden, particularly when a large proportion of patients continue to reach hospitals at advanced stages of the disease.
“We are mopping one corner of the floor while the rest of the floor is still wet,” she said bluntly, underscoring that far more needs to be done to curb the disease through early detection and prevention.
