Cancer prevention starts with understanding you

As a Medical Oncologist, my approach begins with the person in front of me: your age, health, family history, lifestyle, previous illnesses, exposures and, when relevant, inherited Cancer risk. Around that information, we apply the best available scientific evidence to decide which Cancers you may actually be at risk for, which screening tests are appropriate, when screening should begin, how often it needs to be repeated, whether genetic assessment is relevant, which vaccinations can reduce Cancer risk, and, importantly, which tests you do not need.

The whole you: a personalised approach to Cancer prevention

Science should surround the person. The person should not have to fit into a protocol.

Why Cancer screening matters

Screening looks for Cancer or precancerous changes before symptoms develop. A person who already has a breast lump, unexplained bleeding, a persistent cough, altered bowel habits, unexplained weight loss or another concerning symptom needs diagnostic evaluation, not routine screening. See Cancer Diagnosis & Diagnostic Tests.

When used in the right population, established screening programmes can detect some Cancers earlier and reduce Cancer-related mortality. Screening can also lead to false-positive results, unnecessary procedures and overdiagnosis, which is why I prefer risk-appropriate screening to indiscriminate testing. India recorded approximately 1.41 million new Cancer cases in GLOBOCAN 2022, with breast, lip/oral cavity and cervical Cancers among the most frequently diagnosed. [1]

Breast Cancer screening

Breast Cancer screening should consider both age and individual risk. For women at average risk, mammography reduces breast Cancer mortality in the age groups in which organised screening has been studied. International guidelines differ on the exact starting age and interval, and many now begin around age 40. [2] In India, the national population-based programme includes clinical breast examination for women aged 30-65 years. [3]

Women with a strong family history, a pathogenic hereditary Cancer variant, previous chest irradiation or other high-risk features may need a different strategy, sometimes including earlier mammography and/or breast MRI. The better question is not “at what age should every woman get a mammogram?” but “what is this woman’s breast Cancer risk, and what screening strategy fits that risk?”

Cervical Cancer screening

Cervical Cancer is unusual among Cancers because persistent infection with high-risk human papillomavirus (HPV) is responsible for the great majority of cases, which gives us effective opportunities for both vaccination and screening. HPV testing, cervical cytology and, in appropriate settings, other validated approaches can identify women who need further evaluation. India’s national programme includes cervical Cancer screening for women aged 30-65 years, and WHO guidance in 2026 continues to support HPV DNA-based screening as the preferred primary approach where programmes can implement it appropriately. [3,4] Screening remains important even in vaccinated populations, because vaccination does not eliminate every potential cervical Cancer risk.

Oral Cancer screening

Oral Cancer deserves particular attention in India. The national programme includes visual examination of the oral cavity in adults aged 30-65 years. [3] Risk assessment matters most for people with current or previous exposure to tobacco, smokeless tobacco, gutka, paan or betel nut/areca nut, and significant alcohol use. Persistent oral ulcers, white or red patches, unexplained oral bleeding, difficulty swallowing or a neck swelling should not wait for a screening visit. They need clinical evaluation.

Colorectal Cancer screening

Colorectal Cancer can sometimes be prevented by finding and removing precancerous polyps before they progress. Options include FIT or other stool-based testing, colonoscopy and other validated approaches, depending on the individual and the healthcare setting. Several international guidelines recommend routine screening from around age 45 for average-risk adults, adapted to the person’s risk profile and local recommendations. [2] Earlier assessment may be appropriate with a strong family history of colorectal Cancer, previous polyps, inflammatory bowel disease, Lynch syndrome, familial adenomatous polyposis or another recognised hereditary predisposition.

Lung Cancer screening

Lung Cancer screening is not a routine CT scan for everyone. Low-dose CT can reduce lung Cancer mortality in carefully selected people at high risk because of age and substantial smoking history. [2] The possible benefit has to be balanced against false-positive findings, radiation exposure and investigations for abnormalities that may never become clinically significant. I therefore assess smoking exposure, age, overall health and suitability for definitive treatment before recommending it.

Prostate Cancer screening

There is no single PSA screening schedule that is right for every man. PSA testing can detect prostate Cancer earlier, but it can also find Cancers that might never have caused harm during a lifetime, leading to extra imaging, biopsies and sometimes unnecessary treatment. Screening should involve a discussion of age, family history, inherited risk, general health, life expectancy and the person’s own preferences. [2]

Vaccination can also prevent Cancer

Some Cancers are caused by chronic infections, which means vaccination can prevent a proportion of future Cancers.

HPV vaccination

HPV vaccination protects against the high-risk HPV types responsible for cervical Cancer and several other HPV-related Cancers. WHO identifies girls aged 9-14 years as the primary target population, ideally before exposure to HPV, with schedules that vary by age, immune status, vaccine product and national recommendations. [5] Vaccination may also suit selected older adolescents and adults after an individual discussion. It prevents infection. It does not treat an established HPV infection or replace cervical Cancer screening.

Hepatitis B vaccination

Chronic hepatitis B infection increases the risk of liver Cancer (hepatocellular carcinoma). Making sure hepatitis B vaccination is up to date, and identifying people who need testing for chronic hepatitis infection, is another important part of Cancer prevention.

Lifestyle matters, but prevention is more than lifestyle

Cancer cannot always be prevented, even when someone follows a healthy lifestyle, and prevention should never become blame. At the same time, several modifiable exposures meaningfully influence Cancer risk: WHO identifies tobacco, alcohol, high body mass index, low fruit and vegetable intake and physical inactivity among the major modifiable contributors to Cancer mortality. [6] The goal is not perfection. It is to identify the changes that can meaningfully reduce your risk.

• Avoiding tobacco in all forms
• Limiting or avoiding alcohol
• Maintaining a healthy body weight
• Regular physical activity
• A predominantly plant-rich diet with limited processed meat
• Vaccination against Cancer-associated infections where appropriate

When should genetic testing be considered?

Genetic testing is extremely useful in the right person. It is not a routine Cancer screening test for everyone. I consider hereditary Cancer risk more carefully when there is Cancer at an unusually young age, several close relatives with related Cancers, multiple Cancers in the same person, ovarian Cancer, male breast Cancer, certain pancreatic or prostate Cancers, or a known Cancer-predisposition variant in the family.

When indicated, genetic counselling and carefully selected germline testing can help decide whether someone needs earlier or more frequent screening, different screening methods, risk-reducing strategies, or testing of other family members. The test should follow the clinical question, rather than the clinical decision following an indiscriminately ordered panel. See Precision Oncology for testing of the tumour itself.

Personalised Cancer prevention

Not everyone needs every test. This is the principle at the centre of my preventive oncology practice. A personalised Cancer risk assessment may consider age and sex, personal medical history, family Cancer history, tobacco, alcohol and other exposures, previous biopsies, polyps or abnormal screening results, reproductive and hormonal history where relevant, previous radiation or Cancer treatment, possible hereditary risk, and vaccination history. From there, we build an evidence-based plan for what you may need now, what can wait, and what may not be necessary at all.

Prevention without fear

Prevention should not create anxiety about discovering disease everywhere. It should create clarity. I see prevention as a partnership between you and your healthcare team: understanding your risk, discussing the evidence, acknowledging the limitations of screening, and making decisions together. Every test should have a reason, every recommendation should have evidence, and every plan should consider the whole person.

Common questions

This page is general information, not medical advice for your situation. Screening recommendations vary between organisations and change over time, so the right plan for you depends on your individual risk. Medically reviewed by Dr Sneha Kommineni.