It’s not about that, that’s not relevant to ccache at all. (And yes, C23 does have __has_include, though not a lot of compilers have C23 yet.) It’s about having potentially conflicting headers in the source file’s directory, in your -I directories, and in your /usr/include directories.

Suppose a previous compile correctly resolved <libfoo.h> to /usr/include/libfoo.h, and that file remains unchanged, but since that time you’ve installed a private build of libfoo such that a new compile would instead resolve that to ~/.local/include/libfoo.h. What you want is to record not just that your compile opened /usr/include/libfoo.h (“positive dependencies” you get with -MD et al.), but that it tried $GITHOME/include/libfoo.h, ~/.local/include/libfoo.h, etc. before that and failed (“negative dependencies”), so that if any of those appear later you can force a recompile.