Cancer is a major and growing global health crisis, placing an immense and escalating burden on the health systems of developing countries like India. Given the substantial resources demanded by curative management, a strategic investment in comprehensive cancer prevention and control becomes not merely prudent but imperative. India faces a high incidence of tobacco and lifestyle-related cancers, which are largely preventable through robust public health approaches, including tobacco control, cessation support and Human Papilloma Virus vaccination. This narrative review critically assesses the status of cancer prevention and control services in India, highlighting key achievements, inherent challenges and potential threats to progress. While India’s National Programme for Prevention and Control of Non-Communicable Diseases has initiated population-based cancer screening and expanded regional cancer centers, actual gains have been limited. This is due to implementation delays, suboptimal technical capacity and resource limitations in preventive services. Despite notable successes in areas like the cancer registry network, tobacco control legislation and the establishment of the National Cancer Grid, a consolidated and strategically implemented plan to effectively mitigate the projected increase in cancer burden remains a significant challenge.