The wait starts long before the doors to the outpatient department of Hyderabad’s Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Center – commonly known as MNJ Cancer Hospital – open.
By morning the hospital was already filled with patients. Cars, two-wheelers and ambulances jostle for every available parking space as people, many of them accompanied by worried family members, move towards the outpatient block carrying thick bundles of medical records, scan reports and medicine packets. Some have traveled overnight from districts hundreds of kilometers away, while others have been referred from government hospitals that lack specialized oncology services.
Every seat inside the outpatient block is occupied. Those who arrive late sit outside on the stairs and move forward as the queue grows. Across from the entrance, an unpleasant odor emanates from the public toilet, adding to the discomfort of patients preparing for an already long day.
The crowd grows denser with each step inside. Long queues have formed at the registration counters, while an even bigger crowd waits outside the radiation oncology section. Despite the crowd, there is some impatience. For many, this is not their first visit.
Mohammad Usman, 26, a resident of the city’s Moula Ali, says, “My mother was diagnosed with a brain tumor about two years ago. We first went to Osmania General Hospital in Hyderabad, but she was referred here. Since then we have been coming regularly. The doctors are good and we get medicines from the hospital pharmacy.”
Among those waiting is Shekhar, 44, from Adilabad, who is watching his son check the schedule of his next radiotherapy session. He says, “Last year I was diagnosed with oral cancer, possibly due to chewing gutkha. We went to a government hospital in our district, but they said such cases are treated only in Hyderabad. It is very crowded here, but treatment that would cost lakhs in a private hospital is available free here.”
For thousands of people, MNJ is much more than Telangana’s largest government cancer hospital. This is the final stop in a referral chain spanning the entire state and neighboring Andhra Pradesh. The crowds thronging its corridors every day speak not only about the growing burden of cancer, but also about the healthcare system that is still concentrated around a few specialized facilities in Hyderabad, a reality that the government now hopes to better understand through its first comprehensive cancer registry.
According to the Telangana Cancer Atlas, prepared using data from Rajeev Aarogyasri Health Care Trust between April 2020 and September 2025, more than 1,00,294 unique cancer patients received treatment under the state’s flagship health insurance scheme over the five-and-a-half-year period, an average of about 18,235 patients annually. Cancer emerged as the second most treated condition under Aarogyasri after kidney diseases, with around 4,96,552 treatment episodes.
a growing burden
MNJ itself treated 34,256 patients during the study period, making it the largest cancer treatment facility in Telangana. It is followed by Basavatarakam Indo American Cancer Hospital and Research Institute with 21,508 patients and Nizam Institute of Medical Sciences (NIMS) with 8,641 patients.
The findings show that despite government institutions having the largest number of individual cancer centres, private hospitals collectively treat a larger share of patients under the Aarogyasri scheme. Of the 1,00,294 patients analyzed, 53,523 (53.4%) got treated in private hospitals, while 43,480 (43.4%) got treated in government hospitals, while 3,291 (3.3%) got treated in both the regions.
The burden of cancer is spread across all 33 districts of Telangana, although not equally. The number of patients treated under Aarogyasri is highest in Hyderabad (12,517), followed by Rangareddy (6,372) and Medchal (5,483).
However, adjusted for population, Hanumakonda recorded the highest annual incidence of 79 cases per lakh population, ahead of Hyderabad (72) and Karimnagar (65). Overall, 25 districts recorded incidence rates of more than 45 per 1 lakh population, underscoring that cancer is no longer confined to the state’s largest urban centres.
It was also found that the disease is affecting people in their most productive years. The number of patients increases rapidly after the age of 33, with the highest number of cases being recorded in the 39-48 age group, followed by those above 62 years of age. Nearly 60% of all patients treated under Aarogyasri were women, with breast and cervical cancer contributing majorly to the overall burden.
The health department estimates that 55,000 to 60,000 new cancer cases are now reported annually in Telangana, with this figure expected to increase in the coming years. Still, even these numbers tell only part of the story. Cancer Atlas is limited to Aarogyasri beneficiaries, leaving out thousands of patients who do not seek treatment outside the scheme or at health facilities linked to it.
For years, policy makers have tried to plan cancer services without knowing the true scale or geographic spread of the disease. This is a gap that the government is now trying to bridge.
counting begins
On April 6 this year, Telangana declared cancer a notifiable disease, making it one of the few states in the country where reporting of every diagnosed case is mandatory. Until now, cancer data was largely limited to institutional registries managed by MNJ and NIMS, offering only a fragmented picture of the disease burden.
Under the new policy, every diagnosed case, whether identified in a government or private hospital, pathology laboratory or diagnostic centre, must be reported through an online portal within a month of diagnosis. The registry will collect data on cancer incidence, prevalence, mortality, treatment patterns and geographical distribution, with MNJ designated as the state’s center of excellence to verify the information before forwarding it to the National Cancer Registry program under the Indian Council of Medical Research.
“We have started collecting this year’s data and hospitals have started recording cases every day. However, this is a completely new system and health workers in the districts need training. The data needs to be carefully filtered to eliminate duplicate entries as the same patient may visit multiple hospitals. It will take at least six months before we see meaningful trends and about a year to get a clear picture of the cancer burden across Telangana,” MNJ director Says Sadashivudu Gundeti.
Once district-wise patterns emerge, the data can help the government identify high-burden areas, strengthen screening and awareness programmes, improve palliative care and plan new cancer facilities where they are needed most. Dr Gundeti says regular review meetings are already being held with district medical and health officers to improve reporting.
The pressure is evident on the MNJ itself, which registers around 500 new outpatients every day, in addition to thousands of follow-up visits every month.
The government has also begun decentralization of cancer care. In September last year, it inaugurated day care cancer centers in 34 government general hospitals across Telangana, offering screening, diagnosis, chemotherapy and palliative care, allowing many patients to receive follow-up chemotherapy close to home instead of traveling to Hyderabad again and again. Regional cancer centers are also planned across the state by 2030.
But many oncologists believe that better data alone will not reduce the burden on hospitals like MNJ.
A senior oncologist, requesting anonymity, says identifying more patients will inevitably put more pressure on an already strained healthcare system. While the state has expanded the number of beds in MNJ over the years, the doctor argues that increasing capacity within a single hospital cannot be a substitute for developing comprehensive oncology services in the districts.
The Telangana Cancer Atlas appears to confirm those concerns. Although nearly two-thirds of the 81 hospitals empaneled under Aarogyasri for cancer care are government hospitals, private hospitals treated a slightly larger share of patients, accounting for 53.4% of all cases under the scheme compared to 43.4% in government institutions. Doctors say this not only reflects patient choice but also the disparity in infrastructure and availability of advanced treatment options.
“Patients from Adilabad and many other districts travel hundreds of kilometers away to Hyderabad because treatment is not available close to home. Merely increasing beds in MNJ will not solve the problem. Similar infrastructure, specialists and treatment facilities will have to be developed in peripheral districts so that patients can get care closer to their homes,” says the doctor.
a spread system
The gap extends beyond reach. While Aarogyasri has significantly reduced out-of-pocket expenses for patients treated in government hospitals, advanced therapies such as immunotherapy and targeted therapy are largely unavailable in the public sector, forcing many patients to turn to private hospitals despite the higher costs.
Infrastructure barriers are perhaps most visible in radiation oncology. According to another doctor, there are four radiotherapy machines at MNJ, but only one remains fully operational. Despite this, the institute continues to manage 400 to 500 patients requiring radiation therapy every day using a single functioning machine.
“Radiotherapy equipment requires substantial capital investment. Each machine costs around ₹30 crore. Replacing old machines and expanding radiotherapy capacity should be among the state’s priorities if it wants to improve cancer care,” says the doctor.
The challenge extends beyond equipment. A comprehensive cancer care system also requires oncologists, oncology nurses, pathology services, chemotherapy units, operation theaters and palliative care facilities specially trained outside Hyderabad. However, for the patients waiting every day outside the MNJ, debates about registries and health care planning remain far from their immediate concerns. Their priorities are far more basic: securing an outpatient appointment, completing chemotherapy on time or getting a slot for radiotherapy.
Telangana’s decision to make cancer a notifiable disease, for the first time, promises to provide a comprehensive picture of the state’s cancer burden. But the true measure of the initiative will not lie in the number of cases recorded in the database; This will depend on whether these numbers translate into more hospitals, more specialists, better-equipped cancer centers and treatment available closer to patients’ homes. For the crowds that gather outside MNJ every morning, that change can’t come soon enough.
