TLDR: Cancer survival depends more on when you find it than what treatment you get. Localized cancer has 80-99% survival rates, metastatic cancer has single digits. We pour resources into new treatments while ignoring screening. If you’re in your 20s-30s, your parents are entering peak cancer risk age and probably aren’t getting screened properly. The most useful thing you can do is book them a screening package and document your family’s cancer history for yourself.

My mum was diagnosed with HER2+ breast cancer recently. I’ve spent the last month sitting in hospitals, talking to oncologists, and learning more about cancer than I ever wanted to know.

One thing kept coming up in every conversation, every paper, every video I watched: we’re optimizing for the wrong thing.

What do people think matters most in cancer survival?

When someone says “cancer research,” the image that comes to mind is scientists in labs developing the next breakthrough therapy. Treatment advances like immunotherapy, CAR-T cells, and precision medicine get the headlines and the funding, and for good reason. My mum is on TCHP, a regimen that includes Herceptin and Perjeta, which are targeted antibodies that attack HER2-overexpressing cells specifically. Twenty years ago, HER2+ breast cancer was among the deadliest subtypes, and now it’s among the most treatable because of exactly this kind of research.

But here’s what the survival data actually shows:

Localized cancer, caught early while still in one place, has an 80-99% survival rate. Regional cancer that has spread to nearby tissue drops to 20-25%. Metastatic cancer that has spread throughout the body lands in single digits.

Same disease, completely different outcomes based on when you find it.

What’s the actual bottleneck?

Detection timing, by a massive margin.

Greg Simon ran Biden’s Cancer Moonshot and was in charge of coordinating the entire US cancer effort. He also has leukemia himself. When asked why we don’t prioritize early detection more, his answer was blunt: “Money. Lack of focus. And there’s not a lot of glory in creating an early detection program compared to developing a new drug.”

New treatments are exciting and screening programs are boring, so we keep pouring resources into making late-stage cancer slightly more survivable while people die of early-stage cancers that a basic blood test could have caught.

Why does this matter if you’re in your 20s or 30s?

You’re probably not at high cancer risk yourself, but your parents are entering the age range where cancer becomes common. Half of all men and a third of all women will be diagnosed with some form of cancer in their lifetime, and most of those diagnoses happen after 50.

I realized I had no idea what tests my parents should be getting, how often, or where to get them done in India. The information exists but it’s scattered across medical guidelines, diagnostic chain websites, and oncologist recommendations that assume you already know the basics.

What should your parents actually be getting tested for?

For your mother, the big three are breast cancer, cervical cancer, and colorectal cancer.

Breast cancer is the most common cancer in Indian women, and mammography every 1-2 years starting at age 40 is the standard recommendation. There are also newer AI-powered thermal imaging options that work particularly well for women with dense breast tissue where mammograms can miss things.

Cervical cancer is almost entirely preventable with screening, yet only 1.9% of eligible Indian women have ever been screened. A Pap smear or HPV test every 3 years from age 21-65 catches precancerous changes before they become cancer.

Colorectal cancer is rising in India and often ignored because the screening involves either a colonoscopy or talking about stool samples. The recommendation is colonoscopy every 10 years starting at 45-50, or an annual stool test which is simpler and can be done at home.

For your father, prostate cancer screening through PSA testing is worth discussing with a urologist starting at age 50, though it’s controversial because of false-positive rates. Oral cancer is where India has genuinely high rates due to tobacco and paan usage, and if your father uses tobacco or areca nut, annual visual oral examination catches precancerous lesions early. The Kerala Oral Cancer Screening Trial showed 81% mortality reduction through simple visual screening. If your father is or was a heavy smoker, annual low-dose CT for lung cancer is the only screening proven to reduce lung cancer deaths in smokers.

Most diagnostic chains offer bundled cancer screening packages that include tumor markers, basic imaging, and consultations. For parents who haven’t been screened in years, these packages cover the essentials without requiring you to coordinate individual tests.

What about more comprehensive screening?

Full-body MRI scans are available in India and screen for tumors across brain, spine, chest, abdomen, and pelvis in a single session. Worth knowing that MRI can’t evaluate lungs well and has high false-positive rates for incidental findings, so it’s an addition to standard screening rather than a replacement.

Multi-cancer blood tests are newer and genuinely interesting. Some Indian companies now offer tests that screen for 30+ cancer types from a single blood draw, with clinical validation showing around 90% sensitivity. These complement standard screening rather than replacing it, but if you want comprehensive coverage, they’re worth looking into.

What changes if there’s family history?

This is where screening recommendations shift significantly.

The general rule is to start screening 5-10 years before the earliest age of diagnosis in your family. If your mother was diagnosed with breast cancer at 45, you should start mammograms at 35-40 rather than waiting until 50.

Genetic testing becomes relevant when patterns suggest hereditary mutations. Consider it if a parent was diagnosed with breast or ovarian cancer before 50, if multiple family members have the same cancer type, if there’s a family history of multiple different cancers, or if male breast cancer appears anywhere in the family.

One finding that surprised me: 30% of Indian breast and ovarian cancer patients carry hereditary mutations, compared to about 12% in Western populations. If there’s family history, testing is more likely to find something actionable here than the international statistics might suggest. Tata Memorial Hospital offers free genetic testing for eligible patients, and several commercial labs offer BRCA testing with genetic counseling included.

Does HER2 status matter for family members?

Since my mum has HER2+ breast cancer, I looked into this specifically. HER2 status is not hereditary because it’s a somatic mutation that happens after conception rather than something present in the germline that gets passed down.

However, there’s a documented association between HER2+ breast cancer and TP53 mutations (Li-Fraumeni syndrome), particularly when diagnosis happens before age 41. If there’s a pattern of multiple cancers at young ages in your family, or rare cancers like childhood sarcomas, TP53 testing is worth discussing with a genetic counselor.

For most people whose parent has HER2+ breast cancer without other red flags, standard population screening guidelines apply.

What should you actually do with this information?

For your parents over 50, the starting point is booking a comprehensive screening package if they haven’t been screened recently. Make sure mammography is happening for your mother every 1-2 years, get colorectal screening started, and if there’s tobacco use, add oral cancer screening to the list.

For yourself, start by documenting your family’s cancer history including cancer type, age of diagnosis, and every blood relative you can gather information on. If that history shows patterns like multiple cases, young ages, or the same cancer types recurring, pursue genetic counseling. And start age-appropriate baseline screening, which means Pap smears from 21 for women and self-exams monthly.

The conversation to have with your parents is simple: ask when their last cancer screening was. Most won’t have a clear answer. Book it for them.

Early detection has better survival statistics than any drug we’ve developed, and the constraint isn’t technology. It’s getting people to actually use what already exists.