In my clinical practice in Mumbai, over the past five years, I have observed something disquieting: an increasing proportion of cancer patients are under 40 years of age. This is not just one hospital’s anecdote — recent data confirms this trend across India. A study by Cancer Mukt Bharat shows about 20% of all cancer cases in India now occur in individuals below 40 years. Men constitute around 60% of these young patients, women about 40%. As an oncologist, I want to argue strongly that this shift is not merely due to better diagnostics or increased awareness- lifestyle factors are playing an outsized role.

1. Lifestyle and environmental culprits
Dietary change, processed and ultra-processed foods
Indian diets are rapidly transforming in urban areas. There is far greater consumption of ultra-processed foods loaded with preservatives, high sugar, refined carbohydrates, unhealthy fats. These foods promote obesity, insulin resistance, chronic low-grade inflammation — all are well-established cancer risk factors.

2. Sedentary work habits
Between corporate offices and more and more time at home, the younger Indians are not moving much as earlier generations. Exercise lowers immune service, deteriorates metabolic condition, and increases chances of cancers such as breast, colon, pancreas. Obesity is another epidemic that is playing a part in this trend and it is among the younger Indians.

3. Environmental exposure and pollutionThe Indian cities are full of carcinogens in the air and water: particulate matter, industrial effluents, heavy metals. These play a direct role (by inhalation, ingestion) as well as indirect (by inflammation, oxidative stress) roles in oncogenesis. Cities are exposed to young inhabitants that are below 40 years of age.

Consequences and Gaps
1. Late‐stage at diagnosis
Although the cases are increasing, a significant proportion of patients found at stage III or IV are young. Misinterpretation of early symptoms, lack of awareness and screening of cancers among the younger populations is still optimum. The Cancer Mukt Bharat records that approximately 63% of the cancer to which young patients are diagnosed is at an advanced stage in their sample.

2. Gender disparities
Higher cancer incidence in young men (≈ 60%) may reflect more frequent tobacco and alcohol use, greater occupational exposure, and perhaps poorer health-seeking behaviors. Women do have risk too, often compounded by hormonal, reproductive and environmental factors.

What must be done: My prescription
1. Broaden screening guidelines
We must move beyond age 50 as a default starting point for many cancer screenings. High-risk younger cohorts (due to family history, lifestyle, environmental exposure) should be identified and monitored.

2. Health education from early age
Schools, colleges, workplaces must teach nutrition, physical activity, avoidance of tobacco and alcohol. Media campaigns should emphasize that cancer is not just a disease of the old.
3. Urban Planning & Environmental Policy
Reduce air pollution, ensure clean water, regulate industrial emissions, control exposure to known carcinogens. These are not glamorous medical interventions, but their long term impact is immense.
4. Accessible Preventive Services
Make dietary counselling, exercise facilities, tobacco cessation programs and early diagnostic clinics more accessible- particularly in urban lower-middle class areas. Cost should not be a barrier.

Conclusion
The rising incidence of cancer in Indians under 40 is real, steep, and- in large part- preventable. As oncologists, public health practitioners and policy-makers, we cannot accept this as fate. If processed diets, inactivity, pollution and delayed recognition continue unchecked, the cancer burden will shift further to younger cohorts, with tremendous human, social and economic cost. But with concerted action in prevention, early screening, and policy reforms, we can turn the curve. Young Indians deserve nothing less.

Dr. Kiran Tamkhane- Cancer Physician- M|O|C Thane & Kalyan