Introduction:
The Supreme Court of India has called upon States and Union Territories that have not yet classified cancer as a notifiable disease to consider doing so, emphasising the importance of a uniform system for mandatory reporting of cancer cases and deaths across the country. The direction was issued by a Bench comprising Chief Justice of India Surya Kant, Justice Joymalya Bagchi and Justice V. Mohana while hearing a Public Interest Litigation seeking a nationwide framework for notifying cancer as a notifiable disease.
The proceedings arose against the backdrop of concerns regarding the absence of a uniform mechanism for recording cancer cases and cancer-related deaths in India. Although cancer is a major public health concern, its notification has not been uniformly adopted across the country. According to the Union Government, 17 States and Union Territories had already notified cancer as a notifiable disease, while the remaining jurisdictions were yet to take such a step.
A notifiable disease is one which, once diagnosed or otherwise identified in circumstances covered by the relevant notification, is required to be reported to government authorities by healthcare professionals, medical institutions or other designated persons. Such reporting enables public authorities to maintain reliable epidemiological records, monitor disease patterns and formulate appropriate public-health policies.
Traditionally, mandatory notification has been associated primarily with communicable diseases such as tuberculosis, malaria and dengue. Cancer, by contrast, is a non-communicable disease. However, the Parliamentary Standing Committee on Health and Family Welfare, in its 139th Report titled “Cancer Care Plan and Management: Prevention, Diagnosis, Research & Affordability of Cancer Treatment”, specifically recommended that cancer should also be classified as a notifiable disease.
The Committee’s recommendation was based substantially on the need to address deficiencies in cancer-related data. It observed that the absence of mandatory reporting could result in under-reporting of cancer deaths. In several cases, the actual cause of death may not be properly captured in official records, with deaths instead being attributed to broad causes such as cardio-respiratory failure. Such gaps can affect the government’s ability to determine the true burden of cancer and to design effective healthcare interventions.
The Committee had endorsed the suggestion of the Tata Memorial Centre that cancer should be made a notifiable disease so that cancer-related deaths could be mandatorily reported to the government. It considered that a comprehensive database could provide more accurate information concerning the incidence and prevalence of cancer and assist policymakers in identifying risk factors, designing screening programmes and determining the allocation of resources for cancer prevention and treatment.
The Committee had also suggested the development of a CoWIN-like digital platform for cancer registration and real-time collection of cancer-related information. Such a system, coupled with counselling and supportive resources, could potentially provide authorities with a more comprehensive understanding of the country’s cancer burden.
It was in this context that the Supreme Court considered the prayer for a uniform nationwide policy. During the hearing, Chief Justice of India Surya Kant questioned why the Union Government could not issue mandatory guidelines to ensure consistency among the States and Union Territories. The Court’s concern was essentially directed towards avoiding a fragmented system in which cancer would be mandatorily reported in some parts of the country but not in others.
The Union Government, however, pointed out that public health is primarily a State subject and informed the Court that 17 States and Union Territories had already acted upon the recommendations of the Parliamentary Standing Committee. The Supreme Court consequently examined the issue within the constitutional framework governing the respective roles of the Union and State Governments.
Arguments of the Parties:
The petitioner, through the Public Interest Litigation, sought directions for cancer to be notified as a disease across the country. The central concern underlying the petition was the absence of uniformity in the reporting of cancer cases and deaths. The petitioner effectively sought to ensure that cancer-related information would be systematically captured and communicated to government authorities rather than depending upon varying practices followed by individual States, Union Territories or healthcare institutions.
The case for mandatory notification was rooted in the public importance of accurate cancer data. Cancer treatment and prevention policies necessarily depend upon reliable information regarding the number of cases, geographical distribution, mortality patterns and the nature of the disease burden. Where reporting is voluntary, incomplete or inconsistent, the resulting database may fail to reflect the actual prevalence of cancer.
The petitioner could also rely upon the recommendations of the Parliamentary Standing Committee on Health and Family Welfare. The Committee had already examined the issue in detail and recommended that cancer be classified as a notifiable disease. Its observations highlighted the problem of under-reporting, particularly in relation to cancer deaths. The petitioner therefore sought implementation of a recommendation that had emerged from a parliamentary examination of cancer care and management.
The demand for uniformity also acquired significance because cancer does not remain confined within State boundaries. Patients frequently travel between States for diagnosis and treatment, while specialised cancer centres receive patients from different parts of the country. Consequently, fragmented reporting mechanisms may make it difficult to obtain a complete picture of the national cancer burden.
The petitioner could further contend that mandatory notification would not merely serve statistical purposes. Reliable data could support early identification of disease patterns, facilitate targeted screening programmes, help authorities identify risk factors and enable better distribution of medical infrastructure, medicines and financial resources. Accurate mortality data could also help authorities assess whether existing cancer-control measures are producing the intended results.
On the other side, the Union Government raised the constitutional and administrative dimension of the issue. Appearing for the Union Government, Additional Solicitor General Anil Kaushik submitted that health is a State subject. The submission indicated that the Union Government could not simply disregard the constitutional distribution of legislative and executive responsibilities while attempting to impose a uniform mechanism upon all States and Union Territories.
The Union Government also informed the Court that 17 States and Union Territories had already notified cancer as a notifiable disease. This demonstrated that a substantial number of jurisdictions had accepted the recommendation contained in the Parliamentary Standing Committee’s report and had already introduced a mechanism for mandatory reporting.
The Union’s position therefore placed the question within the larger federal structure. Since public health falls primarily within the domain of the States, decisions concerning notification of diseases may ordinarily require action by the competent State authorities. A direction requiring immediate nationwide implementation would consequently have to account for the constitutional powers of the respective governments.
At the same time, the hearing revealed that the Union Government was being asked to consider whether some form of mandatory framework or guidelines could nevertheless be formulated to promote uniformity. The Chief Justice specifically questioned why mandatory guidelines could not be issued to all States and Union Territories so that there would be a consistent national approach.
Thus, the issue before the Court was not merely whether cancer should be notified. It also involved the manner in which such notification could be implemented while respecting the division of governmental responsibilities. The Court had to balance the need for uniform public-health data against the constitutional position that health is primarily within the State sphere.
Court’s Judgment:
The Supreme Court recognised the importance of establishing a consistent mechanism for cancer notification throughout the country. The Bench recorded that 17 States and Union Territories had already notified cancer as a notifiable disease in light of the recommendations contained in the 139th Report of the Parliamentary Standing Committee on Health and Family Welfare.
Rather than immediately issuing a blanket direction requiring every State and Union Territory to notify cancer, the Court directed those jurisdictions which had not yet done so to consider the recommendations of the Parliamentary Standing Committee and take an appropriate decision. This approach allowed the Court to address the public-health concern while taking into account the federal distribution of powers highlighted by the Union Government.
The Court’s observations also reflected a broader concern regarding uniformity. During the hearing, Chief Justice of India Surya Kant questioned the Union Government as to why mandatory guidelines could not be issued for all States and Union Territories. The CJI stressed that there should be a uniform policy, particularly when the issue concerns systematic collection of health data on a disease of such national importance.
The Court’s emphasis on uniformity is significant. Cancer surveillance cannot be fully effective if the underlying data is collected according to substantially different standards in different parts of the country. A patient diagnosed in one State may be captured in official cancer statistics through mandatory reporting, whereas an equivalent diagnosis in another State may not be reported in the same manner. Such differences can distort national statistics and make meaningful comparisons difficult.
Mandatory notification is particularly relevant to mortality data. The Parliamentary Standing Committee had noted that cancer deaths may sometimes be recorded under other immediate or general causes of death, including cardio-respiratory failure. Although such descriptions may accurately identify the physiological mechanism of death, they may fail to capture the underlying disease responsible for the patient’s condition. If cancer is not systematically recorded, policymakers may consequently underestimate the number of people dying from the disease.
The Court’s order must therefore be understood in the context of evidence-based public-health administration. A government cannot effectively plan cancer screening, prevention and treatment programmes without knowing the scale and distribution of the problem it seeks to address. Reliable notification can help generate the data necessary for identifying high-burden regions, vulnerable populations and emerging trends.
The Parliamentary Standing Committee’s recommendation provides an important policy foundation for the Court’s approach. The Committee had accepted the view that cancer should be treated as a notifiable disease despite being non-communicable. The fact that notification is traditionally associated with infectious diseases does not mean that mandatory reporting is legally or administratively inappropriate for a non-communicable disease. Notification is ultimately a mechanism for obtaining information necessary for public administration.
The Court’s order also has significance for the development of cancer registries and digital health infrastructure. The Parliamentary Committee had recommended a CoWIN-like portal for cancer registration and real-time data collection. Although the Supreme Court’s present order does not itself establish such a portal, systematic notification could provide the foundation for creating a more comprehensive national database.
A reliable cancer database could have several practical consequences. It could assist authorities in understanding incidence and prevalence, studying regional variations, identifying possible risk factors and planning screening programmes. It could also help in deciding where cancer hospitals, diagnostic facilities, oncology specialists and treatment resources are most urgently required.
The issue is particularly important in a country as geographically and socio-economically diverse as India. Access to cancer diagnosis and treatment varies considerably across regions. Without accurate data, resource allocation may be based on incomplete estimates rather than actual requirements. Mandatory notification could therefore contribute to more rational healthcare planning.
The Court, however, did not overlook the federal dimension. The submission of the Additional Solicitor General that health is a State subject was taken into account. Rather than treating the matter solely as one of judicial command, the Court directed the remaining States and Union Territories to consider the recommendations and make an appropriate decision within their respective spheres.
The direction to file compliance affidavits further ensures that the matter does not remain merely advisory. By requiring States and Union Territories to report their compliance, the Court has created a mechanism through which their responses can be placed before the Court and monitored. The direction thus provides institutional follow-up to the Court’s concern regarding nationwide consistency.
No specific judicial precedent was relied upon in the order as the basis for the direction. Instead, the Court’s approach was informed by the recommendations of the Parliamentary Standing Committee, the existing action of 17 States and Union Territories and the broader need for uniformity in public-health reporting.
The order also illustrates the Court’s approach to public-interest litigation in areas involving healthcare administration. Rather than prescribing the precise administrative architecture through which cancer notification must operate, the Court has directed the competent authorities to consider an established parliamentary recommendation and take an appropriate decision. This leaves room for the executive authorities to determine the precise mechanism while keeping the issue under judicial scrutiny.
The distinction between cancer being non-communicable and its being made notifiable is particularly important. Notification does not necessarily mean that the disease is infectious or that it poses a transmission risk. It simply means that information concerning the disease must be reported to the designated authorities because such information is considered necessary for public administration and health planning.
In the case of cancer, the justification lies principally in surveillance, accurate data collection and healthcare planning. Mandatory reporting could bridge the gap between the number of cases actually occurring and the number reflected in official records. It could also improve the quality of information concerning cancer-related deaths.
The Supreme Court’s intervention therefore goes beyond the technical question of disease notification. At its core is the principle that effective public-health policy must be founded upon accurate and comprehensive information. Without reliable data, even well-designed cancer-control programmes may be unable to reach the populations and regions that require them most.
The final direction was accordingly measured but significant. The Court recorded that 17 States and Union Territories had already notified cancer as a notifiable disease pursuant to the recommendations of the Parliamentary Standing Committee. The remaining States and Union Territories were directed to consider those recommendations and take an appropriate decision. They were further directed to file compliance affidavits before the Court.
The order consequently places the issue of nationwide cancer notification firmly within the domain of public-health policy while encouraging greater uniformity among States and Union Territories. It also highlights the importance of coordination between the Union and State Governments when dealing with health challenges that have national consequences.
Ultimately, the Supreme Court’s intervention seeks to ensure that cancer is not treated merely as an individual medical problem but also as a matter requiring systematic governmental attention. A reliable nationwide reporting mechanism can help reveal the true burden of cancer, improve planning and enable public authorities to respond on the basis of evidence rather than incomplete statistics. By asking the remaining States and Union Territories to reconsider the Parliamentary Committee’s recommendation and requiring compliance affidavits, the Court has taken an important step towards developing a more consistent framework for cancer surveillance in India.