I vividly remember my first day as a DNB trainee in Medical Oncology at Amrita Institute of Medical Sciences in Kochi in 2007. Dressed in civilian clothes but still carrying the imprint of my 12 years in uniform, I walked into my professor’s room and—out of sheer habit—snapped to attention and saluted. Dr Ganesan, our senior professor and a respected name in oncology circles, looked up, blinked, and let out a surprised laugh. Over time, this little anecdote became a running joke in the department, and to his credit, he told it with affection, not derision.

That day encapsulated something deeper than just muscle memory. It was the beginning of my transition from a military medical officer to a cancer specialist in a civilian academic institute—yet I never truly left the world of uniformed medicine behind. When my friend and former colleague, Dr  Boben Thomas, asked me to contribute a piece on oncology in the Armed Forces for this conference souvenir, I was both honoured and nostalgic. Having served in the Indian Air Force (IAF) from 1995 to 2020, I’ve seen first-hand how the military handles cancer care—quietly, efficiently, and with a few surprises for those on the outside.

"Do You Even Get Cancer in the Army?"

One of the most common questions I was asked during my training—and even later—by civilian colleagues was: “Do you really see cancer in the armed forces? Aren’t your patients all young and fit?” The assumption is understandable. The public associates the military with youth, fitness and discipline. But the truth is, cancer doesn’t discriminate. Our patient population in the Armed Forces Medical Services (AFMS) is far broader than just serving soldiers. We treat their families—including spouses, children and dependent parents—as well as retired veterans. This brings in a spectrum of cases as varied as in any large civilian oncology centre.

The Framework: MDTCs and Tri-service Coordination

Cancer care in the Indian Armed Forces is delivered through a network of seven Malignant Disease Treatment Centres (MDTCs) located at Command Hospitals in Delhi, Chandigarh, Mumbai, Pune, Bangalore, Kolkata and Lucknow. Each MDTC is a multidisciplinary unit with medical, surgical and radiation oncology services working in close coordination. The centres function under the broader AFMS, a unified tri-service organisation encompassing the Army, Navy and Air Force, overseen by the Director General of Armed Forces Medical Services (DGAFMS) and service-specific DGMS.

Funding comes directly from the Ministry of Defence, and while the centres may not boast the glitz of high-end private hospitals, they offer comprehensive care that is protocol-driven, evidence-based and remarkably egalitarian.

What’s Similar: Cancers, Treatments, Patients

At a glance, cancer care in the armed forces mirrors that in the civilian world. Breast, lung, head and neck, gastrointestinal and genitourinary cancers dominate the caseload. Treatments follow global standards: chemotherapy, targeted therapy, immunotherapy and radiation protocols align with national and international guidelines. The expectations of patients—hope, clarity, empathy and timely treatment—are universal, whether the patient wears a uniform or not.

What’s Different: A System Like No Other

While the disease and its treatment are similar, the context in which care is delivered is distinct in several key ways:

1. Regional Variations in Disease Patterns

Each MDTC sees patterns shaped by local epidemiology. When I was posted to Lucknow, gallbladder cancer was disproportionately common—in my first outpatient clinic alone, I saw 15 cases, more than I’d seen in years elsewhere. This necessitated local experience and adaptability even within a nationally integrated system.

2. Transfers: A Double-Edged Sword

In the military, everyone moves. Oncologists, nurses, technicians—everyone is posted every 3–4 years. The upside? Cross-pollination of skills, shared best practices and broad experience. The downside? Institutional memory suffers, team dynamics are disrupted, and continuity in long-term oncology programmes can be challenging.

3. Command and Compliance

Orders are followed without question. In a cancer unit, this means rapid implementation of decisions, excellent infection control, and disciplined follow-up. But rigid hierarchies can also stifle open discussion or discourage innovation unless leadership is progressive and encourages dialogue.

4. Universal Healthcare—Truly

Perhaps the most profound difference: cost is never a factor. Every treatment—from the most basic to cutting-edge immunotherapies—is funded by the government. During my civilian training, I was unsettled when chemotherapy options were described like car models: “This one’s more effective but costs more; this one’s cheaper but older.” In the forces, we simply follow the evidence. If a drug is approved for service use, it’s available to all who need it—irrespective of rank or wallet.

5.Ethical Allocation

Expensive drugs aren’t rationed arbitrarily. The Armed Forces Oncology Group (AFOG)—a panel of senior oncologists—has previously issued consensus treatment guidelines to ensure fair use of limited resources. If a drug isn’t feasible to provide to all eligible patients, it isn’t used selectively. Equity trumps prestige.

6. Freedom from Commercial Pressures

No profit targets, no marketing teams, and no competition between departments. This allows oncologists to focus purely on patient care. Unlike government hospitals, there’s also insulation from political interference. The result? A quieter, more focused, more humane practice environment.

Challenges in the Military Model

Of course, no system is without its limitations. Some of the challenges we faced—and still face—in AFMS oncology include:

• Paper-Based Records: Despite the high-tech aura of the military, our oncology records were largely handwritten. Patients carried their own MDTC books, making data aggregation for research or audit difficult.

• Siloed IT Systems: Interoperability is a casualty of military compartmentalisation. Army, Navy and Air Force hospitals function on separate, often non-digitised systems. Inter-centre communication is limited, and real-time sharing of imaging, pathology or treatment data is rare.

• Administrative Restrictions: Working in secure environments imposes IT and infrastructure limitations. Cloud storage, open-source tools, or even simple software updates are not straightforward.

• Loss of Continuity: Frequent personnel transfers result in a loss of continuity in clinical leadership and programme implementation. Initiatives often lose momentum when the key champions move on.

Lessons for the Civilian Sector

Despite these constraints, there’s much the civilian healthcare system can learn from the armed forces model:

1. Evidence-Based, Not Profit-Based

In the military, oncologists are not incentivised to choose one drug over another. The ethos is to treat according to guidelines, not margins. This philosophy could benefit civilian care—particularly in private hospitals—where the line between medicine and commerce can blur.

2. Punctuality and Professionalism

If a typical oncology MDT/tumour board meeting in the forces starts at 0800 hours sharp, you’re expected to be there by 0750. This culture of timeliness and responsibility builds trust, reduces delays and enhances morale. It's a simple but powerful principle.

3. Consensus Guidelines

Much like NICE in the UK or AFOG in the forces, Kerala or other Indian states could benefit from locally tailored, resource-aware cancer care guidelines. Uniform standards help streamline training, procurement and audit.

4. Collective Bargaining for Lower Prices

The military negotiates drug and equipment prices as a bloc. Civilian states—or medical consortiums—could emulate this to lower costs for high-value therapies like checkpoint inhibitors or CAR-T cell therapies.

5. Try to overcome the challenges we faced by leveraging your advantages

Government hospitals and other hospitals in the private sector are not constrained by the high security IT and other hardware/software restrictions that we face. They have  an opportunity to build smarter, more connected systems before these become entrenched problems.

Final Thoughts

Cancer care in the armed forces exists in a unique ecosystem—shielded from market forces, driven by protocol, and tempered by discipline. While not perfect, it offers a compelling model of ethical, equitable and effective oncology practice. My journey from a saluting trainee to a uniformed consultant—and now an oncologist in another healthcare system —has given me a ringside view of both worlds.

Perhaps the time has come to bridge the gap: not by copying wholesale, but by adopting the best elements from each. Discipline and empathy, evidence and access, humility and ambition—they all have a place in the cancer care of tomorrow.