Sumana* was an energetic child until she turned 11. Then she began complaining of tiredness, could no longer play as she previously used to, and fell ill frequently. Her appetite declined, and a paediatrician advised investigations.
A blood test that her parents thought was routine revealed the possibility of leukaemia.
It took her mother, Varalakshmi*, several months to come to terms with the diagnosis. By then, nearly a year had passed. Sumana had become increasingly weak and listless. When treatment intensified, she had to drop out of class 9. A year later, however, after the completion of her treatment, she was ready to return to school. Today, Sumana is a schoolteacher. She married a year ago, bringing immense happiness to her parents.
Sumana was fortunate. She lived in a metropolitan city with access to specialised healthcare; her parents ensured she completed treatment, and their financial circumstances enabled them to support her. She also had leukaemia, one of the most common and highly treatable childhood cancers.
Not every child is as fortunate.
Childhood cancer burden in India
India, home to about 380 million children below the age of 14, accounted for the largest share of childhood cancers in the South Asian Association for Regional Cooperation (SAARC) region, according to a new study published in The Lancet Regional Health Southeast Asia. The study,, estimates 37,716 new childhood cancer cases and 17,698 deaths annually across the region in 2022. India accounted for 25,939 new cases, or 68.6% of the regional total.
“Leukaemia was the most common cancer in all countries (35–50%), followed by central nervous system (CNS) tumours (approximately 12% of cases),” the study states.
GLOBOCAN 2022, produced by the International Agency for Research on Cancer (IARC), combines cancer-registry data and vital statistics with region-based modelling where registry coverage is partial or absent. The estimates, therefore, may not represent every case diagnosed in India.
Gaps in data
Oncologists say better reporting has increased the number of cases being identified as healthcare expands, but substantial gaps in cancer registration—particularly in rural areas—mean many cases may still go unrecorded.
Venkatraman Radhakrishnan, professor of paediatric oncology at the Cancer Institute, WIA, Chennai, and one of the study’s authors, points to earlier estimates by Ramandeep Singh Arora, published in Indian Pediatrics. Based on the 2011 Census, that study estimated that 52,366 children aged 0–14 and 76,805 children and adolescents aged 0–19 could develop cancer every year.
Narendra Agarwal, senior haematologist and transplant physician and head of the haematology unit at Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, says the higher reported numbers may partly reflect better reporting as the country’s healthcare system expands.
“We are still struggling with the expansion of our healthcare systems. It is possible that the incidence per 100,000 population may genuinely be higher in some parts of India compared with other parts of the world, but there is no strong data to establish this,” he says, adding: “Facilities are expanding rapidly, which is one reason why more patients are now being treated and more cases are being reported.”
Many cancers are curable
The good news is that many childhood cancers have excellent cure rates, given early diagnosis and prompt, comprehensive treatment.
For leukaemia, cure rates can reach 80–90% in many children, Dr. Agarwal says. “Most of these children can lead a near-normal life after treatment.” About 10–15% may experience a relapse after completing treatment, while some may develop long-term effects, including problems with growth and persistent aches and pains.
The challenge, therefore, is not simply whether India knows how to treat childhood cancer. It is whether every child who needs treatment can reach it and complete it.
Why are cure rates uneven in India?
Despite the fact that the prognosis for many childhood cancers is good, cure rates continue to remain uneven in India. According to the World Health Organization, in high-income countries, where comprehensive services are generally accessible, more than 80% of children with cancer are cured. In most low- and middle-income countries, less than 30% are cured
Delayed diagnosis, advanced-stage presentation, treatment abandonment due to financial constraints, infections, malnutrition and limited access to specialised paediatric oncology services, all complicate cure and survival rates.
The Central government’s Ayushman Bharat scheme provides health cover of up to ₹5 lakh per family. Initial standard treatment in government hospitals is either free or heavily subsidised, while NGOs sometimes help bridge gaps in treatment costs at corporate hospitals, says Dr. Radhakrishnan. But costs can rise sharply if treatment fails or the cancer relapses.
“If the initial treatment fails or the child experiences a relapse, treatment is usually more expensive because some of the drugs used are costly,” says Dr. Agarwal.
Private treatment can also be expensive, not necessarily because of the drugs, but because of investigations, hospitalisation and other charges. For families required to sustain treatment over a prolonged period, the financial burden can result in treatment abandonment.
India does not yet know the full picture
One of the biggest gaps in childhood cancer care in India, points out Arvind Krishnamurthy, deputy medical director at Cancer Institute, WIA., is the absence of a cancer registry covering the entire population.
“This is not unique to childhood cancer. Registry coverage is around 15% of the population, and figures for the rest of the country are extrapolated based on those populations. Coverage is particularly limited in rural areas. Most cancer registries predominantly capture urban populations,” he says.
This makes it difficult to determine where childhood cancer occurs most frequently and whether apparent regional hotspots reflect genuinely higher incidence or simply better reporting. Dr. Agarwal says a national registry could help identify such geographical patterns. A comprehensive registry should record not just diagnosis but also the child’s geographical origin, staging, treatment and outcome, he notes.
At present, 17 of the 36 States and UTs in India have so far notified cancer as a notifiable disease in light of the recommendations made in a parliamentary standing committee report. The Supreme Court, August 11, 2026, directed the other 19 States and Union Territories to declare cancer a notifiable disease as well.
Apart from the numbers a registry would help immensely with other research into cancer, for instance, whether socioeconomic and environmental factors influence childhood cancer: Dr. Agarwal says children from poorer socioeconomic backgrounds may have a somewhat higher risk of certain blood cancers, partly because of greater exposure to infections. .
At present, Dr. Radhakrishnan is leading a paediatric registry effort at the Cancer Institute, WIA, but says the government must encourage hospitals to share data.
What’s ahead for India
India’s cancer treatment infrastructure is expanding rapidly. Almost every State now has a government-sponsored Regional Cancer Centre, while Tata Memorial Hospital-linked centres and oncology departments at AIIMS institutions have expanded access to specialised care.
The country therefore has much of the clinical expertise needed to treat childhood cancers. The challenge now remains in ensuring that children are diagnosed early, reach specialised centres, receive financial and social support, and complete treatment.
“Improving early diagnosis, access to specialised treatment, supportive care and ensuring that children complete their treatment will be important in improving survival rates,” says Dr. Krishnamurthy.
For children like Sumana, such interventions can mean the difference between a diagnosis that ends a childhood—and one that becomes only a chapter in a long life.
(* Names changed to protect privacy)
(R. Sujatha is an independent journalist based in Chennai. sujatha.raghunath@gmail.com)