It starts in the obvious places—tongue, cheeks, gums. However, oral cancer, one of the few cancers that can be detected with a simple oral examination, is still diagnosed too late in India.Nearly 70 to 80 per cent of oral cancer patients in the country are detected only at an advanced stage, when the chance of survival drops dramatically. While the five-year survival rate for early-stage oral cancer is over 80%, the survival rate for late-stage oral cancer is less than 30%. Today, India accounts for almost one-third of the world’s oral cancer burden, turning a largely preventable disease into a silent public health crisis.Doctors say the problem is delay. It usually takes three to seven months from the time a patient first notices symptoms to arriving at a specialized cancer center. Early lesions are usually painless, small, and easily overlooked. Minor ulcers, white spots, or mild discomfort when chewing can be ignored, especially in smokers, until the disease progresses to the point where treatment is difficult.“Early screening can make a huge difference in the outcome of oral cancer,” said Dr. Sultan A Pradhan, a surgical oncologist at the Head and Neck Cancer Institute of India. He said an organized screening program can reduce mortality by 24 to 30 percent by detecting precancerous lesions early. Mobile screening units and community cancer camps have shown that prompt identification can stop cancer before it becomes fatal.The risk factors are well known. More than 90% of oral cancer cases in India are related to tobacco use, especially smokeless tobacco such as gutka, kani and betel nut. Alcohol further increases the risk. Doctors also report rising rates of HPV-related oral cancers among younger patients with no history of smoking, extending the risk beyond traditional groups.Once patients enter the system, specialist hospitals play a vital role, integrating early detection pathways with advanced surgery, reconstruction and team care. But clinicians stress that even the best technology cannot fully offset the damage caused by late diagnosis. Oral cancer remains one of the few cancers for which recognition and timely referral can save more lives than any single drug or machine.Meanwhile, cancer care is moving beyond what a scan can show. Dr Shrinidhi Nathany, consultant molecular hematologist and oncologist at Fortis Memorial Institute, explains that tumors smaller than 5 mm are usually not detectable through CT or PET scans. Blood tests that analyze circulating tumor DNA, or ctDNA, can detect bioactive disease, early relapses and treatment resistance months before scans show any changes.In India, where repeat imaging is expensive and often inaccessible, such tests can help reduce unnecessary scans and ineffective treatments. Used judiciously, genomics can reduce overall costs while enabling more precise, timely care.Oral cancer doesn’t hide. It appears in public. Experts say that the tragedy is not that it cannot be seen, but that it often does not receive timely attention.
