The study analysed cancer incidence and mortality across 43 geographic regions in India using data from 2015-2019, with projections for 2024.
Published Sep 02, 2025 | 7:00 AM ⚊ Updated Sep 02, 2025 | 7:00 AM
Cancer.
Synopsis: Southern India is witnessing a cancer crisis of unprecedented proportions. While Kerala dominates the cancer landscape in South India, other states in the region presented a more complex picture with significant variations between urban centres and state averages.
Southern India is witnessing a cancer crisis of unprecedented proportions, with Kerala showing alarming state-wide cancer rates, and major urban centres like Hyderabad, Bangalore, and Chennai reporting some of the highest incidence rates in the country. The data was recorded in a comprehensive study published in JAMA Open Network by the National Cancer Registry Programme (NCRP) led by the Indian Council of Medical Research (ICMR).
The study, analysing cancer incidence and mortality across 43 geographic regions in India using data from 2015-2019 with projections for 2024, reveals that Kerala has emerged as the cancer capital of South India, with all seven of its districts showing consistently elevated cancer rates that far exceed national averages.
In Kerala, the average age-adjusted incidence rate reaches 118.5 per 100,000 for males and 100.6 per 100,000 for females, translating to a lifetime cancer risk of 17.2 percent for men and 13.0 percent for women. This means approximately one in six Kerala men and one in eight Kerala women will develop cancer before age 75, representing some of the highest cancer burdens documented in the country.
“The regional disparities in cancer incidence across India and the increasing cancer burden underscore the urgent need to strengthen the ongoing efforts for cancer prevention and control measures to reduce the burden of cancer in India,” the study states.
While Kerala dominates the cancer landscape in South India, other states in the region presented a more complex picture with significant variations between urban centres and state averages.
Telangana’s capital, Hyderabad, emerged as a major cancer hotspot, particularly for women, recording one of the highest female cancer rates in the country with an age-adjusted incidence rate (AAIR) of 123.8 per 100,000 population and a lifetime risk of 16.7 percent. Interestingly, Hyderabad showed higher female cancer rates than male rates; an AAIR of 92.7 per 100,000 and a lifetime risk of 12.8 percent among males.
This pattern makes Hyderabad unique among major Indian cities, where male rates typically exceed female rates. Breast cancer recorded its highest AAIR in Hyderabad at 54.0, contributing significantly to the city’s elevated female cancer burden.
Karnataka’s Bengaluru presented similar patterns to Hyderabad, with the city recording high cancer rates, particularly among women. Bengaluru showed an AAIR of 121.0 per 100,000 for females with a lifetime risk of 16.5 percent, while an AAIR of 99.9 per 100,000 with a lifetime risk of 14.3 percent was recorded in the case of males.
Both Hyderabad and Bangalore represent the urban metro pattern, where lung cancer emerged as the most frequently diagnosed cancer, especially in metropolitan cities.
Tamil Nadu displayed a stark contrast between its urban centre Chennai and the state average. Chennai, as a pure urban registry, showed significantly elevated rates with an AAIR of 99.6 per 100,000 (lifetime risk 13.3%) among males and 111.0 per 100,000 (lifetime risk 14.9%) among females.
However, Tamil Nadu as a whole presented much lower rates, with an AAIR of just 57.8 per 100,000 (lifetime risk 8.0%) among males and 68.6 per 100,000 (lifetime risk 9.0%) among females, demonstrating the dramatic urban-rural divide within the state. This 42 percent difference between Chennai and the state average for males represents one of the largest urban-rural gaps documented in the study.
Andhra Pradesh showed the lowest cancer rates among South Indian states, with Visakhapatnam recording AAIRs of 39.5 per 100,000 for males (lifetime risk 5.3%) and 53.4 per 100,000 for females (lifetime risk 6.5%). These rates are significantly lower than other South Indian urban centres, with male rates being 67 percent lower than Kerala’s average and 60 percent lower than Chennai’s rates.
This positions Andhra Pradesh as having a relatively moderate cancer burden compared to its neighbouring states.
While South India grapples with its cancer crisis, the most alarming findings come from India’s northeastern states, particularly Mizoram, which reported the highest cancer incidence rates globally among the regions studied.
Aizawl, the capital of Mizoram, recorded the highest AAIR among both males — 256.1 per 100,000 population — and females — 217.2 per 100,000 population — when using the World Standard Population for comparison.
The lifetime risk of developing cancer in Mizoram reached extraordinary levels of 21.1 percent among males and 18.9 percent among females at the state level. Within Mizoram, the district of Aizawl showed an even higher cumulative risk of 26.1 percent for males and 22.1 percent for females, meaning more than one in four men in Aizawl will develop cancer before age 75.
Beyond Aizawl, the northeastern region of India generally reported some of the highest incidence rates, with regions such as East Khasi Hills, Papumpare, and Kamrup Urban consistently showing elevated rates, highlighting what researchers described as significant hotspots requiring immediate intervention.
The study projected that India would face 1,562,099 new cancer cases and 874,404 cancer deaths in 2024, with the country ranking second in Asia and third worldwide in terms of cancer incidence. The lifetime risk of developing cancer in India stands at 11 percent, indicating that approximately one in nine Indians will develop cancer in their lifetime.
The analysis of 708,223 cases from the study period (51.1% female, 48.9% male) and 206,457 deaths (45.0% female, 55.0% male) across 43 population-based cancer registries representing approximately 18 percent of India’s population provides a comprehensive picture of the country’s cancer landscape.
Globally, cancer contributes to approximately 10 million deaths annually, with projections of 32.6 million new cases worldwide by 2045. India’s estimated increase to approximately 2.46 million cases by 2045 aligns with this concerning global trend.
The study revealed distinct gender-specific cancer patterns across the country. For males, the most common cancers are oral, lung, and prostate cancers, with 2024 estimates showing mouth cancer leading with 113,249 cases, followed by lung cancer with 74,763 cases, and prostate cancer with 49,998 cases.
Among females, breast, cervical, and ovarian cancers dominate, with breast cancer projected to affect 238,085 women in 2024, cervical cancer affecting 78,499 women, and ovarian cancer affecting 48,984 women.
Regional variations show that lung cancer emerged as the most frequently diagnosed cancer in the southern regions and metropolitan cities, while mouth cancer is the predominant cancer site in the western, central, and certain northern regions.
Specific cancer sites show remarkable regional concentrations. Breast cancer recorded its highest AAIR in Hyderabad at 54.0, while cervical cancer showed its highest AAIR in Aizawl at 27.1. Lung cancer exhibited the highest AAIRs in Srinagar at 39.5 for males and Aizawl at 33.7 for females. Oral cancer was highest in Ahmedabad Urban at 33.6 for males and East Khasi Hills at 13.6 for females.
The data revealed increasing trends in overall cancer incidence, with a significant increase in AAIR observed in nine populations among males and 14 among females. Notable increases were documented in Kamrup Urban, with males showing a 3.3 percent and females a 2.4 percent increase, and Thiruvananthapuram Taluk showing increases of 2.9 percent in males and 3.4 percent in females.
Oral cancer showed significant increases in 14 Population Based Cancer Registries (PBCRs) among males and four PBCRs among females, with Ahmedabad Urban showing an increase of 4.7 percent among males and 6.9 percent among females. This trend is strongly linked to tobacco and alcohol use patterns across the country.
Lung cancer exhibited a statistically significant increase in five PBCRs for males and nine PBCRs for females, including Kamrup Urban showing increases of 3.8 percent for males and 6.3 percent for females, and Bangalore recording increases of 3.7 percent for males and 5.5 percent for females. Tobacco use remains a major risk factor, with systematic reviews showing a significantly higher risk of respiratory system cancers, with an odds ratio of 4.97.
Interestingly, stomach cancer incidence rates decreased in both males and females, particularly in Aizawl and Mizoram, and the increasing incidence of breast cancer and decreasing incidence of cervical cancer are more associated with generational shifts in risk factors than period effects.
(Edited by Muhammed Fazil.)
