In India today, information travels faster than ever, but lifesaving advances in healthcare still do not reach everyone equally. Cancer care is a stark example of this divide: while patients in metro cities increasingly benefit from early diagnosis and precision oncology, those in Tier 2 and Tier 3 cities often encounter cancer late, at advanced stages, with limited access to specialised oncologists and advanced diagnostics. The result is a much higher mortality-to-incidence ratio in smaller towns and developing regions, not because the cancer is biologically different, but because the systems to detect and treat it early are missing.
Drawing on his experience as COO and Co-Founder of 4baseCare, Kshitij Rishi argues that partnering with regional hospitals to establish local genomic testing capabilities is emerging as a powerful way to narrow this “diagnosis-access gap.” By embedding next-generation sequencing and molecular profiling closer to where patients live, oncologists in smaller cities can move beyond a one-size-fits-all approach to truly personalised cancer care. This shift not only improves the chances of identifying actionable mutations and offering targeted therapies but also reduces the financial and emotional burden of repeated travel to metropolitan centres, making precision oncology a realistic possibility for patients outside India’s big cities.
We live in an age where there is no dearth of information access. Everyone is aware of everything that’s going on across the world, almost on a real-time basis. Yet, this ease of access does not extend to advanced healthcare.
When it comes to cancer care and outcomes, it is a well-known fact that even if the biology of the disease remains the same, the mortality-to-incidence ratio is significantly higher in Tier 3 cities and in developing countries as compared to Tier 1 cities and developed nations. This disparity in cancer outcomes between developed and developing nations, as well as between India’s Tier 1 and Tier 3 cities, is driven by a “diagnosis-access gap.”
In high-resource settings, cancer is increasingly treated as a manageable chronic condition due to early detection (Stage I or II) and use of precision medicine workflows. In contrast, patients in developing regions or smaller Indian towns typically present at Stage III or IV, where treatment is more complex and less effective. This late presentation is exacerbated by a severe shortage of specialized oncologists and lack of advanced medical care and therapeutic infrastructure. Due to these challenges, patients often face a ‘travel burden’ to tier I cities, which leads to financial stress and time constraints for primary breadwinners. This often results in high rates of treatment abandonment and financial exhaustion.
Making precision oncology a reality in tier 2/ 3 cities
The only way to make precision oncology accessible in tier 2 and 3 cities is by taking it closer to patients. Collaboration plays a key role in building this access. Working with hospitals in smaller cities and towns to set up genomics sequencing set-ups can create access to information, better treatment planning and better outcomes.
Establishing local genomic facilities fundamentally shifts treatment from a “one-size-fits-all” approach to precision-based care, which is vital in resource-limited settings. When a local oncologist can identify specific genetic drivers such as EGFR (epidermal growth factor receptor) or ALK (Anaplastic Lymphoma Kinase) mutations, they can prescribe targeted oral medications instead of broad-spectrum, intravenous chemotherapy. This is a game-changer for Tier 3 patients: oral therapies can be managed at home, eliminating the immense physical and financial “travel burden” of frequent trips to metropolitan centers for grueling IV infusions. Furthermore, genomics serves as a financial safeguard; by identifying exactly which drugs a tumor will respond to, it prevents families from exhausting their life savings on expensive “blind” treatments that may offer no clinical benefit for their specific cancer subtype.
This localized precision is further amplified by connecting local hospitals to Virtual Molecular Tumor Boards/ or digital AI-backed clinical decision support systems. While the sequencing machine sits in a Tier 2 or 3 town, the interpretation of that complex data is performed in collaboration with top-tier geneticists via tele-consultation or based on unique interfaces that can match the patients in these towns to our database of similar patients and thereby drive data-backed decisions. Our soon-to-be launched OncoTwin platform is aimed at exactly doing this. This “digital bridging/ twin matching” ensures that the treatment plan is guided by elite expertise, effectively upskilling the local oncologist and providing the patient with a metropolitan standard of care without them ever leaving their district.
Additionally, by slashing the turnaround time for these results from weeks to days, the facility ensures that this targeted plan is implemented while the patient is still healthy enough to benefit, directly addressing the late-diagnosis crisis prevalent in smaller cities.
Impact of genomic testing on treatment decisions and patient outcomes in tier 2 and 3 cities
To understand the impact of genomic testing in smaller cities and towns, let’s look at the LuNGS Alliance initiative by Cancer Research and Statistics Foundation (CRSF) to improve lung cancer treatment in India, specifically in tier II and tier III cities. LuNGS Alliance is a program offering free biomarker testing to lung cancer patients through advanced NGS (Next Generation Sequencing) to ensure targeted and personalized treatment to patients. In just two months, over 1,000 tests were conducted nationwide. Among the first 100 patients tested, 64% were found to have genetic mutations that matched an available targeted therapy. Of these, nearly 75% have gone on to receive those treatments. These targeted treatments often lead to better outcomes than one-size-fits-all treatments.
The data clearly shows that nearly 80% of patients derive some form of actionable insight from genomic testing. Many have been placed on targeted therapies, with several demonstrating strong responses to treatment. Another key benefit observed is that early NGS testing leads to a 55% survival advantage over late testing, translating to a 5.33-month improvement in median survival.
The way forward
We need more nationwide initiatives like the LuNGS Alliance, where doctors are able to decide targeted treatment plans. This has been largely driven by the fact that the test is free for everyone. However, lung cancer is not the only cancer afflicting Indian patients. We need more such initiatives for all other types of cancers, too.
Genomics in cancer care is like a GPS; it shows the right treatment path. But without the “roads” (affordable drugs) and “drivers” (trained oncology professionals), that guidance alone isn’t enough to get patients to the finish line.
So, while building local genomics infrastructure is important, we also need to improve access to treatments and strengthen clinical know-how of advances in precision oncology.
