Bharat Cancer Genome Atlas: Cancer care is now a priority research area worldwide, and oncology has moved from broad protocols to molecular precision. Treatment no longer depends only on where a tumour appears. It increasingly depends on the genetic alterations driving it. For India, this is both a scientific opportunity and a policy test.
Indian clinicians have long relied on genomic studies built largely on Western populations. Cancer biology is not neutral. It is shaped by ancestry, environmental exposure, diet, and the health system. When the data does not represent the patient, treatment decisions are made on partial evidence.
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Bharat Cancer Genome Atlas and Genome Grid
The launch of the Bharat Cancer Genome Atlas (BCGA) and the Bharat Cancer Genome Grid (BCG2) is an important milestone in India’s medical research. IIT Madras has launched the BCGA as a public database of Indian cancer genomes, and BCG2 is intended to help doctors use this evidence in treatment decisions.
Indian patients remain underrepresented in global cancer-genome databases, even as India’s cancer burden rises. Registry-based estimates suggest that one in nine Indians is likely to develop cancer in a lifetime, and millions are living with the disease. Non-communicable diseases now account for most deaths in India, with cancer taking a growing share. A health system of this scale cannot continue to function without locally relevant genomic evidence.
Precision oncology and Indian genetic variants
Cancer is a disease of altered genes. Two tumours that look similar under a microscope can behave differently because their molecular profiles differ. One may respond to a targeted therapy. Another may be resistant from the outset.
Effective cancer treatment therefore requires evidence on genetic variants prevalent in Indian populations. Without that, clinicians risk over-treatment or under-treatment. The case for a public database is practical, not symbolic: it must catalogue variations across cancer types so doctors and researchers can identify patterns and make better therapeutic choices.
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A genome atlas will matter in clinics only if genomic data is linked to standardised clinical metadata and outcomes. Sequence data by itself can map variants; it cannot tell an oncologist which mutation altered response to a specific regimen, which cases relapsed early, or where toxicity forced treatment changes. That requires consistent annotation across centres — cancer type, stage, pathology, line of treatment, response, recurrence and survival — in formats that can be compared. Without this, BCGA risks becoming a valuable research catalogue but not a decision-grade clinical resource.
Genomics for drug development and clinical trials
The value of genomics goes beyond bedside decisions. It also shapes drug development and clinical trials.
Pharmaceutical research has historically centred on North America and Europe. If Indian genomic signatures differ in clinically meaningful ways, therapies developed elsewhere may not deliver the same outcomes in India. The reverse is also true. Mutations that are more common in Indian patients could support the development of targeted therapies for domestic needs. That is how genomics connects to industrial policy: it can help build an indigenous biopharmaceutical ecosystem instead of extending dependence on imported innovation.
Cancer treatment costs and genomic testing
Advanced cancer therapies can cost from a few lakh rupees to well above ₹10 lakh a month, placing severe financial pressure on families. Genomic testing can reduce futile spending if it helps identify which patients are likely to benefit from a high-cost therapy and which are not. It can also reduce unnecessary toxicity.
The economics have become more favourable. Genomic test prices have fallen by roughly 30-40% in recent years. That does not solve the access problem, but it lowers one barrier to wider adoption.
Uneven access to molecular diagnostics
Access remains uneven. Advanced diagnostic facilities are concentrated in metropolitan hospitals. Patients from smaller towns and rural districts travel long distances for consultation and testing, adding delay and cost.
Coverage is another constraint. Even where genomic tests are available, many insurance plans do not cover them. Public health schemes also do not routinely reimburse advanced molecular diagnostics. So lower test prices alone will not produce equitable access without financial protection.
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Cancer genomics workforce and clinical capacity
India also lacks enough genetic counsellors, molecular pathologists, and bioinformaticians. These are not peripheral roles. They interpret test results, explain implications to patients, and help integrate findings into treatment decisions.
That is why genomic expansion cannot be reduced to equipment procurement or database creation. A national atlas must be matched by sustained investment in workforce development and by institutionalising molecular tumour boards beyond elite hospitals.
Health policy, early detection and data governance
The recent Union Budget signalled some progress through higher health allocations, support for domestic pharmaceutical manufacturing, and customs-duty exemptions on selected cancer drugs. These measures may reduce treatment costs. But the larger goal should be to reduce the number of patients reaching advanced stages where expensive therapies become the only option.
Genomics can contribute here too. Better evidence on genetic predispositions and high-risk variants can support more targeted screening strategies.
Data governance will be critical. Public genomic databases must balance openness with privacy. Patients will participate only if they trust that their biological data will be protected and used ethically.
Representation is the harder test. India’s genetic diversity is vast. A credible cancer genome atlas must reflect variation across regions, communities, and socioeconomic groups. If sampling is skewed, the database will reproduce existing inequities.
Partnerships with state institutes and district hospitals will matter as much as the technology itself. So will participation across geographies. The atlas is a strong start because it recognises that Indian patients deserve evidence grounded in Indian biology. The harder task is to move that evidence from research centres into everyday clinical practice.