Inadequate radiotherapy infrastructure and workforce shortages are major drivers of gynecological cancer survival disparities in low- and middle-income countries, but expanding equitable access to radiotherapy could save up to 10 million life years over the next two decades.
- Low- and middle-income countries account for approximately 94% of global cervical cancer deaths, with the highest mortality in East Africa at 35.3 per 100,000 age-standardized rate
- An estimated 1.47 million new cancer cases and over 680,000 cervical cancer deaths occurred in 2022, concentrated disproportionately in resource-constrained settings
- Radiotherapy infrastructure in LMICs remains critically inadequate, with 19.2% of all global gynecologic malignancies occurring where radiation infrastructure is absent or severely limited
- Key barriers include equipment costs, specialist training requirements, and maintenance challenges that prevent access to life-saving treatment
- Closing the radiotherapy gap over two decades could save up to 10 million life years through policy-driven measures, task-shifting models, and international training partnerships
Inadequate radiotherapy infrastructure and workforce shortages are a couple of reasons for survival disparities in gynecologic cancer survival, according to a report published August 24 in Cancer.
A team led by Dewi Setiawati from Universitas Islam Negeri Alauddin in Makassar, South Sulawesi, Indonesia suggested in its report that policy-driven measures toward expanding equitable access to care could help address gynecologic cancer mortality in low- and middle-income countries (LMICs).
“The generations of women who will bear gynecologic cancer diagnoses in LMICs over the coming decades deserve a future in which their survival is not predetermined by their geography, their income, or the health system into which they are born,” the Setiawati team wrote.
LMICs account for about 94% of global cervical cancer deaths, with the highest mortality observed in East Africa at an age‐standardized mortality rate 35.3 per 100,000. An estimated 1.47 million new cancer cases and over 680,000 cervical cancer-related deaths occurred in 2022, with mortality “disproportionately concentrated” in resource‐constrained settings.
Setiawati and colleagues reviewed studies published between 2015 and 2014. They assessed the epidemiology of gynecological cancers such as cervical and ovarian cancer. They also outlined causes of cancer care disparities and how policy decisions could bridge these gaps.
The authors found that survival disparities are driven by the following factors: late‐stage diagnosis, limited screening coverage, inadequate radiotherapy infrastructure, workforce shortages, and restricted access to essential and novel therapies.
For ovarian cancer, the authors noted that diagnostic delays are further compounded by “deficiencies in radiologic and pathologic infrastructure,” as well as limited gynecologic oncology expertise and an inconsistent supply of platinum-based chemotherapy.
They suggested that cost‐effective and scalable interventions like single‐dose human papillomavirus (HPV) vaccination, screen‐and‐treat strategies, HPV self‐sampling, task‐shifting models, and international training partnerships could improve outcomes.
For radiotherapy access, the team reported that the radiotherapy infrastructure in LMICs “remains critically inadequate” with an estimated 19.2% of all global gynecologic malignancies occurring in LMICs where radiation infrastructure is either absent or severely limited. The researchers cited equipment cost, specialist training requirements, and maintenance challenges.
“Modeling studies demonstrate that closing the radiotherapy gap in LMICs over the next two decades could save up to 10 million life years that would otherwise be lost to gynecologic cancers,” the study authors wrote.
Cancer’s editor-in-chief, Suresh S. Ramalingam, MD, in a prepared statement said the review highlights opportunities to reduce the burden of gynecological malignancies in LMICs.
“Gynecological malignancies claim the lives of far too many women globally; implementation of evidence-based tools consistently and uniformly across the world will save numerous lives,” he said.
Read the full study here.
