Beyond One Size Fits All: Precision Oncology for Indian Women

On International Women’s Day, IndiaMedToday spotlights Dr. Anjali Kulkarni (Vice President – RWE Strategy and Analytics, 4baseCare) whose journey from radiation oncologist to medtech leader exemplifies how women in science are reshaping the future of cancer care. In a country where breast and gynaecological cancers account for nearly half of all cancers in women, she champions the shift toward precision oncology — a model that recognises the genetic, clinical and social realities unique to Indian women. By combining data, genomics, and real-world evidence, Dr. Kulkarni advocates for a more inclusive, accessible and personalised approach to cancer prevention, diagnosis and treatment.

Together, breast and gynaecological cancers constitute over half of all female cancer cases in India, with breast and cervical cancers making up 43-45% of all cancer in Indian women as of 2022.  Breast and ovarian cancers show strong genetic predispositions in Indian women. Over 10% of breast and ovarian cancer cases in India are associated with pathogenic BRCA1 and BRCA2 mutations. These mutations are more commonly observed in younger women and in individuals with a strong family history of these cancers.

Genetic testing as a preventive measure

For many Indian women, genetic risks of breast and ovarian cancers are quietly passed down through generations. Genetic testing reveals this inherited risk early, giving women a chance to monitor their health, plan preventive measures, and take proactive steps in time. Many Indian women are coming forward for Genetic counselling and Germline testing to identify the high risk mutations and opt for any prophylactic treatment or close surveillance.

Precision oncology treatment recommendations based on hormonal status and Immuno marker testing is being increasingly adopted in India. With higher incidence of TNBC (triple negative breast cancer), an aggressive subtype of breast cancer, Oncologists are recommending the NGS (Next Generation Sequencing) testing to find out mutations and prescribe immunotherapy or targeted therapies in breast and gynaecological cancers.

In India, women often present with distinct clinical characteristics compared to Western populations, including a younger age at onset, late-stage presentation, and more aggressive biological subtypes. Given these factors and existing resource constraints, real-world evidence plays a critical role in informing clinical practice and improving outcomes.

Real-world evidence (RWE) is instrumental in identifying gaps in screening methods and understanding high-risk social and cultural factors specific to Indian women. Furthermore, analysing treatment data allows us to evaluate the effectiveness of global protocols and monitor toxicity profiles for Indian women.

RWE analysis also helps identify critical bottlenecks in care, such as the significant delay between diagnosis and the initiation of treatment.  For example, there is an urgent need for improved access to gynaecologic oncology specialists, particularly for women in non-metro cities. In case of breast cancer screening, Thermal based imaging has shown promising results in low resource and population based programs.

Making precision oncology accessible beyond metros

As every district has a cancer department, basic tests like IHC (Immunohistochemistry) / PCR and advanced tests like NGS should be included in the vision plan. PPP (Public Private partnership) model may be helpful as seen in some states. There is a need to advocate with policymakers to include NGS-based testing within government healthcare schemes, ensuring that genomic testing becomes an integral component of standard cancer care, at least for selected clinical indications.

Genomics labs and Oncology practitioners in non-metro and tier-2/3 cities can collaborate and build an effective logistics system for sample collection and NGS testing . There should be affordable targeted panel tests designed for specific patient population.

Once the NGS reports are available, making the recommended drugs available to patients within affordable cost is of paramount importance.

Encouraging the wider adoption of genomic tests developed in India using local patient datasets can significantly reduce costs and improve accessibility, making precision oncology more feasible for a larger patient population.

My journey from Radiation Oncology to medtech – How it shaped my perspective on cancer

Radiation oncology is a form of localized treatment modality. My focus was mainly on irradiating tumours and saving normal tissues from toxicity.

As I moved from clinical oncology into medtech, my perspective shifted toward how technology could enable oncologists to deliver more precise and timely treatments. My attention towards consistently delivering quality care with processes and tools increased. Cancer care looked more scalable and accessible through digital means. Remote monitoring, patient communication apps added value to routine personal consultations. Cancer care beyond traditional hospital walls looked feasible.

The journey with data and AI experience in healthcare has been truly transformative. Clinical information recorded in paper notes has traditionally been underutilized, but when digitized, the same data holds immense potential to generate insights and power data-driven solutions. This shift toward structured, digital health data gave a revolutionary perspective in advancing precision medicine and improving patient care. 

AI can play a significant role in reducing administrative and repetitive tasks, allowing clinicians to focus more on patient care. It can also help generate data-driven cancer treatment recommendations based on real-world evidence. In this way, cancer care increasingly becomes a synergy between human expertise and intelligent technology

The need for diverse women’s voices to design the future of cancer care systems

As women contribute to nearly 50% of cancer burden and the cancer incidence pattern is peculiar, there is an urgent need to design cancer care systems tuned to their needs. Treatment protocols and post treatment phase needs for women will be different. Addressing issues like toxicity, body image, and mental health will need special attention. To create a holistic cancer care plan, women will play an important role.

Future cancer systems will consist not only of treatment delivery but include survivorship and rehabilitation. There will be a seamless transition from hospital care to home based monitoring. In such systems women will play a significant role beyond clinical care. Designing products and solutions keeping  women end-users in focus will influence adoption of the system.

As Phygital mode of cancer care becomes a norm, women with various technology adoption levels will be of immense consideration. Urban , rural , professional , homemakers , young and old, and all strata women should be able to navigate systems easily.

Women will play the role of treating doctors, monitoring nurses , counsellors , care givers and decision makers. It’s important to consider these diverse personas in designing effective cancer systems to make it successful. Thus, having diverse women’s voices in future healthcare systems will make it a truly adoptable and inclusive cancer care system.