Childhood cancer on the rise in urban India: Over 60,000 cases yearly

According to Dr Santanu Sen, head of paediatric haematology, oncology, BMT & cellular therapy at Kokilaben Dhirubhai Ambani Hospitals in Mumbai, data from treatment centres in major Indian cities report an increase of 97% over the past 15 years, whereas the global increase is only 13% over a similar period of time. “We are currently seeing over 60,000 new cases every year,” he said.

According to the WHO, in high-income countries, more that 80% of the children diagnosed with cancer are cured, whereas in the case of many low- and middle-income countries, less than 30% are cured. The WHO has set a goal to achieve a 60% cure rate globally by 2030.

Detection, diagnosis, or both?

“In India, both the recorded incidence and the detection rate of childhood cancer are rising,” says Dr Sen, attributing it to “improved diagnostic capabilities, more specialised paediatric oncologists, improved referral networks, better awareness, and more efficient cancer registries”. However, he notes that the higher detection rate of cases is the more significant indicator of the two. “While actual, underlying incidence may be increasing as well due to various factors, a significant portion of the rise is attributed to improved detection, reducing the number of ‘missed cases’,” he adds.

Dr Ashray Kole, haemato-oncologist and BMT physician at MOC Cancer Care and Research Centre, Mulund, agrees that the primary reason for the rise in number of cases is detection and reporting, and not “a dramatic biological surge”. He further reveals that according to the Indian Council of Medical Research (ICMR) and the National Cancer Registry Programme (NCPR), 60,000-65,000 cases of childhood cancer are detected annually in the country. “Data from population-based cancer registries suggest a modest but consistent annual increase of about 0.5% – 1.5% in childhood cancer incidence over the past decade in certain urban registries,” he adds.

However, Dr Sen notes that environmental and biological factors cannot be ignored entirely — causes for childhood cancer incidence also include rising pollution levels and lifestyle factors in urban settings as well, “which may be contributing to a true increase in the biological incidence of the disease”. Dr Kole adds that delayed maternal age, and lifestyle transitions may also contribute marginally to real incidence shifts. 

The most common type of childhood cancer in India is acute lymphoblastic leukaemia (ALL), accounting for approximately 25-35% of all childhood cancers, as per NCRP data. This is followed by brain tumours, lymphomas, Wilms tumour, and bone cancers. In infants, neuroblastoma and retinoblastoma (eye cancer) are also common.

Risks & symptoms

Most cases of childhood cancer do not have an underlying cause, but are brought on by genetic accidents during rapid cell growth. “Only about 5-10% of cases are linked to inherited factors,” says Dr Sen. “Children with Down Syndrome have a significantly higher risk of leukaemia, and conditions like li-Fraumeni syndrome or neurofibromatosis predispose children to various tumours. In other factors, extremes in birth weight (very high or very low) have also been statistically linked to certain paediatric malignancies,” he adds. Dr Kole shares a few other causes of childhood cancer, pointing out family history of cancer, rare inherited gene mutations, high-dose radiation exposure and certain congenital immune deficiencies.

“Environmental links remain under investigation, but pesticide exposure, parental smoking, and industrial pollutants have been studied as possible contributing factors,” he adds. Since routing screening at birth is not possible for childhood cancers, warning signs must be looked out for, which include “persistent fever, unexplained weight loss, unusual bleeding or bruising, prolonged bone pain, white reflex in the eye, persistent swelling, or unexplained lumps”, as per Dr Kole.

As far as incidence within the country is concerned, Dr Sen of Kokilaben Dhirubhai Ambani Hospitals says, “Certain population groups, for example, boys, children in urban areas and for those staying in northern India, show significantly higher reported incidence and vulnerability to paediatric cancers. While some of these patterns reflect biological differences, many are driven by social determinants like gender bias and improved regional healthcare accessibility.”

“We often see more boys being brought to tertiary centres for treatment than girls, particularly in rural areas. Families in rural areas are particularly vulnerable, often arriving with advanced-stage disease because they lack access to local specialists,” he adds.

Dr Sen advises that parents and general practitioners should be aware that any fever, pain, or lump that lasts more than two weeks despite basic treatment needs to be reviewed by a paediatric oncologist. “But all newborn babies must have an eye check by the medical team for a white glow to rule out retinoblastoma. Similarly, if any photos of a child show up with a white glow, they should be screened for the same. For children with a family history of known genetic cancer predisposition syndromes, regular ultrasounds or blood work are advised,” he says, adding, “But in general, cancer screening is not generally advised in children.”

Treatment & access

A Lancet study on global childhood cancer rates published in 2025, based on population-based studies from 2022, revealed that India is the global leader in childhood ALL, chronic myeloid leukaemia (CML) and gliomas of uncertain origin. According to a paper published in the National Centre for Biotechnology Information on cancer care services in India, an ideal paediatric oncology unit consists of dedicated clinicians and nurses trained in paediatric cancer management with sufficient health facility infrastructure, supportive care and availability of chemotherapy drugs in stock. The functioning of a paediatric care unit should also be extended to providing follow-up and palliative care to patients and training and capacity building for health care professionals.

Dr Sen acknowledges that while specialised treatments like bone marrow transplants, immunotherapy, car T cell therapy are expensive, many centres now utilise government schemes like Ayushman Bharat and NGO partnerships to ensure no child is turned away due to lack of funds. Crowdfunding initiatives have also proven to be lifesaving in many cases.

“Cost remains a major barrier,” reveals Dr Kole. “Though government schemes like Ayushman Bharat have improved coverage, many families face indirect costs (travel, accommodation, income loss) when seeking treatment. Treatment abandonment rates in some centres have historically ranged from 10-20%, though structured social support programs have reduced this in organised centres.”

Dr Kole suggests that to ensure awareness and manage further spread of access, the thing to be kept in mind, most pertinently, is strengthening of paediatric oncology units in tier-2 and tier-3 cities. He says that measures to be taken for improved access to treatment should include expansion of cancer registries to rural regions, financial risk protection through insurance and public funding, public awareness campaigns focused on early warning signs, training paediatricians and general practitioners, and last but not least, investment in genomic and epidemiological research.

Dr Sen adds: “We also need to set up local satellite centres in a shared care model with specialised tertiary units, so families don’t have to migrate to metros for every chemotherapy session. It is important to have public campaigns emphasising that childhood cancer is curable to reduce treatment abandonment.”

Paediatric cancers are the most curable cancers with cure rates exceeding 95% in certain cases, says Dr Sen. “To manage the growing rate, we must move beyond the hospital walls: We need general paediatricians and frontline general practitioners to be aware about paediatric cancers and recognize early signs of paediatric cancers,” he adds.