Women in India are more likely to get cancer. Men are more likely to die from it.
The paradox, revealed in a study of the country's latest cancer registry, tells a story at once simple and confounding.
Women account for just over half of all new cases, but men make up the majority of deaths.
India appears to be an outlier. In 2022, for every 100,000 people worldwide, on average about 197 were diagnosed with cancer that year. Men fared worse, at 212, compared to 186 for women, according to the World Cancer Research Fund.
Nearly 20 million cancer cases were diagnosed globally in 2022 - about 10.3 million in men and 9.7 million in women. In the US, the estimated lifetime risk of cancer is nearly equal for men and women, according to the American Cancer Society.
In India, the most common cancers among women are breast, cervical, and ovarian. Breast and cervical cancers make up 40% of female cases.
While cervical cancer is largely linked to infections such as human papillomavirus (HPV), breast and ovarian cancers are often influenced by hormonal factors. Rising cases of these hormone-related cancers are also associated with lifestyle shifts - including later pregnancies, reduced breastfeeding, obesity, and sedentary habits.
For men, oral, lung, and prostate cancers dominate. Tobacco drives 40% of preventable cancers, mainly oral and lung.
So what is going on in India? Is it an earlier diagnosis for women? Are men's cancers more aggressive, or is it that habits such as smoking and chewing tobacco drag down their outcomes? Or does the answer lie in differences in access, awareness and treatment between genders?
Awareness campaigns and improved facilities mean cancers common among women are often detected earlier. With their long latency periods - time between exposure to a cancer-causing factor and the appearance of detectable cancer - treatment outcomes are relatively good.
Mortality rates among women are therefore lower.
Men fare worse. Their cancers are more often tied to lifestyle - tobacco and alcohol drive lung and oral cancers, both aggressive and less responsive to treatment.
Men are also less likely to go for preventive check-ups or seek medical help early. The result: higher mortality and poorer outcomes, even when incidence is lower than among women.
Women's health has become a bigger focus in public health campaigns, and that's a double-edged sword. Greater awareness and screening mean more cancers are detected early. For men, the conversation rarely goes beyond tobacco and oral cancer, Ravi Mehrotra, a cancer specialist and head of the non-profit Centre for Health Innovation and Policy (CHIP) Foundation, told me.
Women, through reproductive health checks, are more likely to see a doctor at some stage. Many men, by contrast, may go their whole lives without ever seeing one, Dr Mehrotra said.
But the real story emerges when the numbers are broken down: India's cancer burden is unevenly spread across regions, and across the types of cancer people face.
Data from 43 registries show that 11 out of every 100 people in India run the risk of developing cancer at some point during their life. An estimated 1.56 million cases and 874,000 deaths are projected for 2024.
The hilly and relatively remote northeast region remains India's cancer hotspot, with Mizoram's Aizawl district recording lifetime risks twice the national average.
Doctors say much of this is down to lifestyle.
For most cancers in the north-eastern state, I'm convinced lifestyle is the key factor. Tobacco use is rampant here - much higher than elsewhere, R Ravi Kannan, head of Cachar Cancer Hospital and Research Centre in Assam, told me.
In Barak Valley in Assam, it's mostly chewing tobacco; just 25km away in Mizoram, smoking dominates. Add to that alcohol, areca nuts, and even how meat is prepared. Food choices and preparation drive cancer risk. There's no special cancer-causing gene at play - hereditary cancers aren't more common here than in other parts of India, Dr Kannan said.
But the pattern isn't confined to the northeast. Srinagar in Indian-administered Kashmir tops the charts for lung cancer in men, while southern Hyderabad city leads in breast cancer. Men in the capital, Delhi, are being diagnosed with all cancers put together at a higher rate than men in other regions, even after correcting for age differences.
Oral cancer is also rising: 14 population registries report increases among men and four among women.
India's patchwork of risks is part of a larger truth: cancer is at once the most universal and the most uneven of diseases. The disparities seen across Indian states mirror a global divide shaped by geography, income, and access to care.
In wealthy nations, one in 12 women will be diagnosed with breast cancer during her lifetime, but only one in 71 will die from it, according to WHO.
In poorer countries, the picture is reversed: just one in 27 women will ever receive a diagnosis, yet as many as one in 48 will die of the disease.
Women in lower Human Development Index (HDI) countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying of the disease due to late diagnosis and inadequate access to quality treatment, says Isabelle Soerjomataram, Deputy Head of the Cancer Surveillance Branch at International Agency for Research on Cancer (IARC).
Yet amid this shifting landscape, many questions remain, underscoring the urgent need for targeted prevention, early detection, and lifestyle changes, including healthier diets and habits.
