Mangayarkarasi V, Durairaj Elantamilan, Ramanathan Vijaya
Microbiology, All India Institute of Medical Sciences, Madurai, Madurai, IND.
Anatomy, All India Institute of Medical Sciences, Madurai, Madurai, IND.
Cureus. 2025 Feb 10;17(2):e78808. doi: 10.7759/cureus.78808. eCollection 2025 Feb.
This review addresses the significant challenges and technological developments in cancer screening and early diagnosis in the context of India's diverse and resource-constrained healthcare landscape. Selected cancers like breast, cervical, oral, lung, and colorectal cancers are focused on, and established screening methods such as clinical breast examination (CBE), mammography, visual inspection with acetic acid (VIA), HPV DNA testing, and oral visual inspection (OVI) are reviewed. These are cost-effective strategies that are proven to reduce mortality. However, they face systemic barriers, including low awareness, socio-cultural stigma, and discontinuous healthcare access. Emerging technologies in cancer screening like liquid biopsy (detecting circulating tumor DNA), artificial intelligence (AI)-driven imaging (enhancing radiological accuracy), next-generation sequencing (identifying genetic mutations), and methylation-based ctDNA analysis (epigenetic profiling) are considered to be transformative in cancer management. Digital pathology and telemedicine are also found to improve diagnostic precision and rural/remote outreach. However, high costs, technical complexity, and limited validation in Indian settings are the major challenges that hinder their widespread adoption. The review emphasizes the need for culturally tailored awareness campaigns, integration of screening with the already existing public health programs, and increased investments in indigenous research to address genetic and environmental risk factors. It specifically advocates for strengthening the primary healthcare infrastructure, training community health workers, and leveraging mobile screening units to bridge urban-rural disparities. A combination of scalable low-resource methods and strategic adoption of emerging technologies can help in mitigating India's growing cancer burden. This aligns with global targets to reduce premature non-communicable disease (NCD) mortality by 2030. This synthesis of evidence-based practices and innovative strategies offers a roadmap for policymakers and stakeholders to enhance equitable cancer care delivery nationwide.
本综述探讨了在印度多样化且资源有限的医疗环境背景下，癌症筛查和早期诊断所面临的重大挑战以及技术发展。重点关注了乳腺癌、宫颈癌、口腔癌、肺癌和结直肠癌等特定癌症，并对临床乳腺检查（CBE）、乳房X线摄影、醋酸目视检查（VIA）、HPV DNA检测和口腔目视检查（OVI）等既定筛查方法进行了综述。这些都是经证实可降低死亡率的具有成本效益的策略。然而，它们面临系统性障碍，包括认知度低、社会文化耻辱感以及医疗服务获取不连续等问题。癌症筛查中的新兴技术，如液体活检（检测循环肿瘤DNA）、人工智能（AI）驱动的成像（提高放射学准确性）、下一代测序（识别基因突变）以及基于甲基化的ctDNA分析（表观遗传学分析），被认为在癌症管理方面具有变革性。数字病理学和远程医疗也被发现可提高诊断精度并扩大农村/偏远地区的覆盖范围。然而，高成本、技术复杂性以及在印度环境中验证有限是阻碍它们广泛应用的主要挑战。该综述强调需要开展针对文化背景的提高认知运动，将筛查与现有的公共卫生项目相结合，并增加对本土研究的投资，以应对遗传和环境风险因素。它特别主张加强初级医疗基础设施，培训社区卫生工作者，并利用移动筛查单位来弥合城乡差距。可扩展的低资源方法与新兴技术的战略采用相结合，有助于减轻印度日益增长的癌症负担。这与到2030年降低过早非传染性疾病（NCD）死亡率的全球目标相一致。这种基于证据的实践与创新策略的综合为政策制定者和利益相关者提供了一个路线图，以在全国范围内加强公平的癌症护理服务。
