1. A Brief History of Cancer in India
Cancer is believed to have existed within India for centuries (Suraiya, 1973).
However, before 1900 there were only 35 cancer cases that were recorded in Indian medical
literature (Elmslie, 1866; Suraiya, 1973; Tomes, 1880). The first mention of cancer in
modern India came in 1866 when a physician by the name of Elmslie reported 30 cancer
cases seen in his medical practice. Elmslie observed what would come to be known as two
types of cancer that are specific to India, Kangri and Dhoti cancers. Nonetheless, these
reports had little influence, and it was not until the beginning of the 20th century when the
question of whether cancer existed in India truly came to be considered.
The time period of 1900-1910 featured a rise of cancer’s appearance within Indian
medical discourse (Neve, 1902; Niblock, 1902). It came to be accepted that cancer certainly
existed within India. Indian physicians began to claim that not only did cancer exist within
India, but that it was also a common illness among the native races of India. However,
physicians from the global north contested the validity of these arguments on the grounds that
there lacked comprehensive epidemiological data on cancer in India (Neve, 1902; Rogers,
1900; Sutherland, 1904). This resulted in a number of medical publications from the global
north asserting claims along the lines that “cancers are rare in the dark races … I do not think
cancer or other malignant disease is by any means so common among natives in India as in
Europe” (Buchanan, pp. 311, 1900).
The result was another two decades of silence for cancer discourse, treatment, and
recognition. It was not until the 1930s when Indian physicians began to address the lack of
epidemiological data they were confronted with, and made use of the small amount of data
that they did have (Megaw and Gupta, 1927; Nath et al., 1933; Nath and Grewal, 1935). The
result was a small amount of attention paid to cancer both socially and among Indian medical
literature. However, this was not significant enough to have any affect upon either data
collection or cancer treatment, allowing cancer to remain a silent killer. It was not until the
1940s that the concern for cancer started to be represented in funding. Upon the death of
Lady Meherbai Tata from leukaemia, her husband, Sir Dorab Tata, decided to fund the
creation of the Tata Memorial Hospital (Tata Memorial Hospital, 2016).
The conception of the Tata Memorial Hospital was a monumental event in terms of
providing cancer care in India, and should be seen to have accomplished three major things.
First, patients had an official medium to seek qualified care. Second, it aided physicians in
establishing oncology as a specialty within India (Rai, pp.195, 1953; Chakrovorty, 1961).
Third, it promoted a significant amount of cancer research, and gave cancer care a platform to

2. build upon moving forward. The cancer research that would come out of the Tata Memorial
Hospital would go on to form the Indian Cancer Research Centre (ICRC) in 1952 providing
its own unique contributions (Indian Cancer Research Centre, 1952).
The ICRC focused much of its efforts on exploring the aetiology and genetic
characteristics associated with cancers specific to India. (Indian Cancer Research Centre,
1952). The ICRC specifically investigated Kangri and Dhoti cancers, along with an
additional cancer known as Chutta cancer. As was thought in the late 1800s by Elmsie,
Kangri cancer occurs from the Kangri pot.
Men and women, when walking about out of doors, to carry the kangri under their
loose woollen gowns, and in close proximity with the bare of their abdomen. When in
doors or in a sitting posture, the Kashmiris place the kangri between their thighs. The
fuel consumed in the kangri is charcoal, and the heat evolved is often considerable.
These then are facts concerning epithelioma (Elmslie, pp. 325, 1866).
Dhoti cancer was associated with a specific Kashmiri article of clothing.
Consist fully of one long loose woollen garment … being wide and capacious, the
wearer can with the greatest facility take his or her arms out of them, and being
alongside the body, in immediate contact with the bare skin (Elmslie, pp.325, 1866).
The newly discovered Chutta cancer was a cancer due to smoking.
Regarded by clinicians in this region as due to irritation from the habit of smoking a
local type of cigar, called the Chutta, with its burning end inside of the mouth …
poorer folk resort to the habit of holding the lighted end inside the oral cavity to keep
it burning for a longer time (Khanolkar, pp. 355, 1945A).
The rise in cancer research through the ICRC was only one step in the right direction,
there were also prominent issues of education that needed to be addressed both among
patients and physicians (Indian Cancer Research Centre, 1952; Rai, 1953; Chakrovorty,
1961). Patients were “mostly illiterate and … steeped in ignorance in superstition” (Rai, pp.
395, 1953). Further, physicians did not receive adequate training in medical classes, loosely
correlating with “the fight to get treatment of cancer recognised as a specialty” (Rai, pp. 396,

3. 1953). These combined factors lead to a situation where “80 to 90% of … cancer patients
reach[ed] the doctors in an advanced stage when only some palliation … [was] possible”
(Rai, pp. 395, 1953). To take up these issues of education the Indian Cancer Society (ICS)
was formed. The ICS claimed to have implemented a number of public health campaigns;
however, the first documented campaign was not until the early 1980s (Indian Cancer
Society, 1980). Before this, it appeared to be mainly education for higher caste citizens, the
group which had the lowest of cancer rates (Gopal-Ayengar, 1951; Rai, 1953; Khanolkar,
1946). Even though interventions began in rural areas in the 1980s, the prominent social
education issues that existed at the beginning of the 1900s still exist today: mistrust,
misinformation, stigma, and fear (Khanolkar, 1945C; Rai, 1953; Mallath, 2014).
The accomplishments that the Tata Memorial Hospital, ICRC, and ICS made should
not be overlooked. However, it is also important to analyse some of the barriers that
prevented them from accomplishing comprehensive cancer care. Cancer treatment centres
often provided disproportionate services to higher castes; cancer research often involved a
disproportionate amount of funds allocated to cancers which were not the most common or
pressing form within India; education and cancer awareness were often isolated to higher
castes (Gopal-Ayengar, 1951; Indian Cancer Society, 1980; Nath et al., 1933; Mallath et al.,
2014; Indian Cancer Research Centre, 1952). The following section of this report will
consider what made cancer in India exist in this context, and will attempt to compare those
realities with how cancer is being treated in India today.
North-South Interaction: The Indian Physician’s Navigation of a White Man’s
Discourse
To not pay tribute to the effect that colonisation had on cancer care in India would be
to ignore a pivotal contextual centrepiece of its development. What comes apparent in cancer
discourse specific to India is that its issues with cancer are not allowed to be synonymous to
those in the global north. When Indian physicians first attempted to validate cancer it was
rejected by physicians from the global north who used data from British residents living
within India (Buchanan, 1900). Later, in the 1930s, when cancer in India began to gain
attention, it could only do so in novel forms. Meanwhile, common cancers such as breast
cancer were much more life threatening, and received much less attention (Khanolkar, 1955;
Mallath, 2014). I aim to show that the colonial context that Indian cancer care has developed
in has crippled it even to this day. The precedent that India must exist in a state that

4. represents ‘novel’ forms of cancer still exists, and ultimately ignores some of the more
prominent issues which India faces: a lack of cancer education, and a lack of treatment for
much more common cancers to India (Mallath et al., 2014; Sullivan et al., 2014).
A waste of breath:
The time period of 1900-1910 was the first time that debates took place around the
frequency of cancer in India. These debates resulted in the belief that cancer played an
insignificant role in India’s burden of disease, and should subsequently not be allocated
significant resources (Bashford, 1907). To understand how this conclusion was come to, it is
important to understand both sides of the argument. Indian physicians began to use post-
mortem studies analysing prevalence of causes of death combined with physician observation
and based upon such studies concluded that “the figures given … are sufficient to show that
malignant disease not only occur in natives in India, but they may be said to be common
among them” (Rogers, pp. 280, 1900; Neve, 1902; Sutherland, 1904). Unfortunately, these
arguments failed to provide comprehensive epidemiological data on cancer rates in India, and
were rendered unconvincing (Nath et al., 1933).
Physicians of the global north produced rebuttals to these claims which are accurately
represented by Lazarus’ three critiques to Sutherland.
[i] Difficulty arises in connection with the uncertainty whether a diagnosis has been
made clinically alone or has been verified by a post-mortem examination. … [ii]
There comes the actual question of diagnosis [being correct]. … [iii] It is at least
remarkable, however, from our point of view, that nine cases of sarcoma of the knee,
seven of the shoulder, and four of the elbow should have occurred. In our experience
the joints themselves are affected with sarcoma only in the greatest rarity (Lazarus,
pp. 93-94, 1904).
Lazarus’ critiques, combined with other physicians of the global north, resulted in two
decades of silence for cancer in India.
Cancer’s silence must then beg one to ask why Indian physicians were unable to
prove cancer’s presence. Any potential that cancer had to become validated within India was
undermined by the social, political, and economic factors which affected health care in India
at the time. The only resources physicians had to validate cancer’s common existence within

5. India were existing medical institutions (Megaw and Gupta, 1927). There were several
pitfalls to this approach. First “nine-tenths of the population is settled in villages; a great
majority of these cannot [financially] and do not support a doctor of any description” (Nath et
al., pp.127-128, 1933). Lower social castes did not have the economic mobility to be able to
afford consultations and further, rarely consented to a post-mortem autopsy, leading to their
exclusion in representative studies (Nath et al., 1933). Second, the majority of death
certificates that were available failed to accurately represent the cause of death. “The village
watchman (chowkidar), poor and illiterate, is the diagnostician which reports to the nearest
police station once or twice a month the deaths occurring in his area and the causes as he
knows them. It is this information which is the foundation of Indian vital statistics” (Nath et
al., pp.128, 1933; Nath and Grewal, 1935). Third, “in urban areas certification of death by
registered medical practitioners … [had] not yet become obligatory” (Nath and Grewal,
pp.149, 1935) Fourth, “women entertain a strong and all but insuperable anti towards
European skill and medicine … It seems probable that the apparent dislike of European
physician entertained by native women is mainly … to the evil and bigoted use of their male
relatives and friends” (Elmslie, pp.325 1866). Fifth, because cancer was not perceived to be a
disease of great concern, education was lacking among physicians and patients. Physicians
would be unable to recognise cancers, particularly those beneath the skin, and patients would
be unaware that their symptoms were cancerous and deadly (Megaw and Gupta, 1927).
The perfect storm had emerged. Patients of a lower caste were the predominate group
with cancer and did not have the economic mobility to attend clinics if they had cancer. If
patients of a lower caste did have the economic mobility to attend a clinic, the physician may
not have the training to recognise the cancer. Cancer would not be represented in death
certificates which inhibited comprehensive epidemiological based arguments. Cancer existed
in complete silence.
This array of mounting factors working against Indian physicians effectively inhibited
anyone who attempted to argue that cancer was a disease of concern in India. Physicians of
the global north jumped to the presumption that because cancer could not be proved to exist
at high rates within the global south, then it must be non-existent (Lazarus, 1904). I would
counter that the logical conclusion would instead be that there is simply not enough evidence
to conclude anything. Despite having errors within the data that was presented by Indian
physicians, their claims were arguably more valid than the arguments that emerged from the
global north. Nonetheless, it was common for physicians of the global north to have more
respect within medical literature (Balfour and Young, 1929). Even the most prominent Indian

6. physicians had trained in England before returning to India (Pai, 2002). The result was that
physicians of the global north existed within a scientific hierarchy, allowing them to
effectively take advantage of the shortcomings that Indian physicians faced when attempting
to prove cancer’s high frequency. However, this dominance in medical literature had
consequences, and similar to the way in which cancer would remain silent in medical
discourse until the 1930s, cancer would also silently kill its victims.
Selected interests unrepresentative of patients’ needs
The next era to be noted is between 1930-1960. This time period included an
increased focus in cancer research and the establishment of several organisations including
the Tata Memorial Hospital, the ICRC, and the ICS, which would dedicate themselves solely
to cancer (Tata Memorial Hospital, 2016; Indian Cancer Research Centre, 1952; Indian
Cancer Society, 1980). Cancer had certainly gained attention within India, however it is
necessary to note what type of attention it gained. The efforts made within cancer care began
to focus on cancers which were unique to India, rather than cancers which were most
common within India (Indian Cancer Research Centre, 1952; Khanolkar, 1955). Most notably
was the way in which these cancers were explored. Often, cancer research was more
interested in the socioeconomic and racial divisions that cancer existed within, rather than the
potential treatment for cancer (Indian Cancer Research Centre, 1952).
When Indian oncologists reported on cancer in India at the International Conference
on Cancer (AUICC) their topics mainly featured around cancer cases, types, and initiatives
that were exclusive to India. For example, Kangri cancer was a common topic of discussion
on behalf of Indian oncologists at the AUICC (Ranadive, 1963). Kangri cancer was caused
by the dangling of a pot between the legs to stay warm, and was common among the lower
socioeconomic classes, specifically Kashmiris (Khanolkar, 1945A). Penile cancer was also a
common topic of discussion, and was thought to have resulted due to Hindus’ tendency to not
be circumcised combined with dirty living habits (Khanolkar, 1955). However, liver cancer
and carcinoma of the scalp received fairly little attention at the AUICC, despite reports that
“the number of persons suffering from this type of cancer is proportionately greater than in
England or Australia” (Khanolkar, pp. 57, 1951; Khanolkar, 1945). The cancers that were of
most interest to physicians of the global north were not particularly the most common types
within India, but they were the ones which highlighted India’s poverty and racial divisions. It
should be noted that all six of the conferences presented on cancer in India between 1950-

7. 1963 started with a statement to some degree that cancer in India was as common as it was in
the global north (Khanolkar, 1951; Khanolkar, 1950; Khanolkar, 1959; Gopal-Ayengar,
1951; Rai, 1953; Ranadive, 1963).
There is a general impression that cancer is much rarer in Asiatic and African people
than in the Anglo-Saxon races. Berman has shown that this is incorrect so far as the
Bantu in Africa are concerned. The reports from Japan and the experience of trained
observers in modern medical institutions in India as far apart as Madras, Calcutta,
Lahore and Bombay suggest that the incidence is much the same in Eastern countries
as in Western Europe and North America. … It is found that the mean annual
mortality from cancer in Bombay city per hundred thousand living persons arranged
according to age groups approximates that of New York city and Zurich, if the
suggested corrections are made (Khanolkar, pp.881-883, 1950).
This should be seen as nothing less than a desperate attempt on behalf of Indian physicians to
normalise cancer, perhaps proceeding with the cognition that the only way to begin to receive
international attention for the most prominent cancers in India would be to first appease the
interests of physicians of the global north. Thus, the result was that Indian oncologists
highlighted cancers which revolved around socioeconomic status and racial divides.
These catered discussions then had effects that would be represented in Indian
oncology. First, not only would these discussions come to shape what was researched, but it
would also come to shape how it was researched. First, the Indian Cancer Research Centre
devoted most of its funding towards cancers which were exclusive to India (Indian Cancer
Research Centre, 1952). Additionally, much more Indian medical literature emerged on
cancers which were exclusive to India than cancers that existed globally (Khanolkar, 1945).
When cancer researchers began to look at the aetiology and treatment of cancer, significant
resources were allocated to analysing the relation of genetics and cancer, religion and cancer,
race and cancer, and socioeconomic status and cancer (Indian Cancer Research Centre, 1952;
Sirsat, 1945; Khanolkar, 1944; Khanolkar, 1955). Far fewer resources were spent on
understanding how to treat these types of diseases (Indian Cancer Research Centre, 1952).
Thus, the rhetoric emphasising racial and socioeconomic determinants of cancer used in the
international setting were reflected in the way cancer researchers went about their work.
This racial and socioeconomic approach to cancer also had an inevitable impact on
cancer treatment. Physicians often understood very little about cancer as it was not included

8. in their medical training (Chackrovarty, 1961; Khanna, 1950; Rai, 1953). The result of a
racial and caste based research environment meant that the select physicians that did have an
understanding of oncology would often hold their understandings in racial and caste based
contexts. The physician was enabled to make generalisations about who may or may not have
cancer without analysing the symptoms that the patient would present. Cancer patients were
then subjected to a large amount of stigma (Rai, 1953). Stigma, superstition, fear, and
religious associations began to become assigned to cancer (Rai, 1953). To mediate these
effects, the ICS has had to launch a number of public health campaigns in an effort to raise
awareness about the realities of cancer (Indian Cancer Society, 1980). Even more concerning
is how many of these stigmas, superstitions, fears, and religious based associations still exist
today (Mallath, 2014).
And today?
To say that these factors are only historical would be to entirely forget how cancer has
developed. The global north still plays a significant part in shaping the way cancer is
approached within India. In one of the most recent articles on cancer in India there is a push
for India to take advantage of the opportunity to “contribute and improve understanding for
all cancers through investment in resources and skills and international collaborations that
eventually benefit patients with cancer worldwide” (Sullivan et al., 2014, pp. 217). However,
these global approaches continue to run the risk of pushing Indian physicians to please the
global community. The global north requests that India benefit cancer patients worldwide by
improving the understanding of all cancers. The precedent for India to fulfil this burden has
been by contributing to the knowledge of cancers that are specific to India, thus improving
the “understanding for all cancers.” Unlike what was done in the 1930s, I argue that India
should focus less on contributing to the global repertoire of cancer knowledge, and should
focus more on public health research which can combat their own issues of cancer, often ones
which are also common to the global north. Additionally, efforts need to be taken within
India to gather more comprehensive data on cancer to fully address the problem of cancer in
India. These nation specific efforts will then enable India to fully contribute to this global
repertoire of cancer knowledge that is desired, but India must first prioritise itself. To further
enable this course of action, academics and physicians of the global north should be reflective
upon the implications and power that rhetoric can have. Regardless, current and future

9. recommendations on how to treat cancer in India should be given in the context of the history
of cancer in India, being careful not to repeat some of its inhibitory steps of the past.

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