Integrating Cancer Prevention and Early Detection into Primary Healthcare in India An Evidence-Informed Narrative Review of Community-Based Strategies, Population Screening, Risk Reduction, Early Diagnosis and Continuity of Care for Strengthening Non-Communicable Disease Control

Abstract

Background: Cancer represents a major and increasingly complex non-communicable disease (NCD) challenge, with substantial implications for population health, health-system capacity and socioeconomic well-being. Although advances in cancer diagnosis and treatment have improved outcomes for several malignancies, the public-health burden remains strongly influenced by preventable risk factors, inadequate awareness, delayed presentation, limited screening uptake, diagnostic delays and discontinuities across the cancer-care pathway. In India, these challenges are particularly important because of the country's large and diverse population, substantial rural–urban disparities, variable healthcare accessibility and dependence on primary healthcare for population-level prevention and early detection. Objective: This narrative review aims to examine the role of primary healthcare in integrating cancer prevention and early detection within the broader NCD-control framework in India, with particular emphasis on community-based risk reduction, health promotion, population screening, early recognition of symptoms, diagnostic referral, continuity of care and health-system integration. Methods: An evidence-informed narrative review approach was adopted. Relevant literature concerning cancer epidemiology, modifiable risk factors, community-based prevention, population-based screening, primary healthcare, early diagnosis, referral pathways, digital health, community health workers and continuity of cancer care was conceptually synthesized. Particular attention was given to evidence relevant to the Indian public-health context and to identifying implementation gaps and opportunities for strengthening the cancer-control continuum. Results: The literature indicates that effective cancer control requires a shift from predominantly treatment-oriented approaches toward an integrated prevention-to-care continuum. Tobacco and alcohol exposure, unhealthy diet, physical inactivity, obesity, environmental exposures and selected infectious agents constitute important targets for primary prevention. Community engagement and health literacy can improve recognition of risk factors and warning symptoms, while appropriately implemented screening programmes can facilitate earlier identification of selected cancers. Primary healthcare facilities and community health workers can function as critical points for risk assessment, health education, screening coordination, referral and follow-up. However, fragmented referral pathways, inadequate diagnostic capacity, workforce constraints, socioeconomic barriers, geographical inequity and loss to follow-up can weaken the effectiveness of otherwise well-designed programmes. Conclusion: Cancer prevention and early detection should be positioned as integral components of comprehensive primary healthcare and NCD control in India. A Community-to-Care Cancer Control Continuum, linking population risk reduction, community awareness, screening, early diagnosis, referral, treatment linkage and survivorship-oriented follow-up, may provide a useful conceptual framework for strengthening cancer control. Future research should evaluate context-specific implementation models, equity-sensitive screening strategies, digital innovations and measurable pathways from community-level intervention to cancer outcomes.