Aug 2026· Cancer· Vol 132· 0 citations· 27 references
Medicine
TL;DR
Evidence demonstrates that cost‐effective and scalable interventions—including single‐dose human papillomavirus (HPV) vaccination, screen‐and‐treat strategies, HPV self‐sampling, task‐shifting models, and international training partnerships—can substantially improve outcomes when embedded within national cancer control policies and supported by sustainable financing mechanisms.
Abstract
Gynecologic malignancies—including cervical, endometrial, ovarian, vaginal, and vulvar cancers—represent a major and largely preventable source of mortality in low‐ and middle‐income countries (LMICs). In 2022, an estimated 1.47 million new cases and over 680,000 deaths were reported globally, with mortality disproportionately concentrated in resource‐constrained settings. The survival gap between LMICs and high‐income countries (HICs) remains profound, reflecting systemic policy and health system failures in prevention, early detection, and access to treatment. This narrative review synthesizes evidence from PubMed/MEDLINE, Embase, Cochrane Library, and World Health Organization (WHO) databases, prioritizing literature published between January 2015 and December 2024, with a focus on epidemiology, health system constraints, and policy‐relevant interventions. LMICs account for approximately 94% of global cervical cancer deaths, with the highest mortality observed in East Africa (age‐standardized mortality rate 35.3 per 100,000). Persistent survival disparities are driven by late‐stage diagnosis, limited screening coverage, inadequate radiotherapy infrastructure, workforce shortages, and restricted access to essential and novel therapies. However, evidence demonstrates that cost‐effective and scalable interventions—including single‐dose human papillomavirus (HPV) vaccination, screen‐and‐treat strategies, HPV self‐sampling, task‐shifting models, and international training partnerships—can substantially improve outcomes when embedded within national cancer control policies and supported by sustainable financing mechanisms. Reducing these inequities requires policy‐driven, system‐level reforms that prioritize prevention, strengthen service delivery, and expand equitable access to care, aligning national strategies with global frameworks such as the WHO 90–70–90 targets to achieve sustainable cancer control in LMICs.
This review identifies barriers to effective disease management and discusses the current and future cancer burden across the African continent for non-specialist readers and those seeking to understand oncological care in Africa.
C. Kimwele, Catherine Kaluwa, A. Nyongesa et al.· Cancer Plus· 0 citations
Background: While cervical cancer is highly preventable through the HPV vaccine, early detection, and treatment, it continues to be a significant contributor to the morbidity and mortality of women in Sub-Saharan Africa (SSA). Poorer survival outcomes in SSA compared to high-income countries can, to a large extent, be attributed to patients being unable or unwilling to present to the health system to obtain curative treatment in a timely manner. Time-to-treatment interval (TTI) has gained traction as a key measure of health system performance and is also likely to impact cervical cancer outcomes.
Methods: This narrative review provided a synthesis of available evidence on the role TTIs play regarding cervical cancer and survival in SSA. Various electronic databases and relevant institutional repositories were searched to conduct the review, namely; PubMed/MEDLINE, Scopus, Embase, Web of Science, African Journals Online (AJOL), Google Scholar, GLOBOCAN, IARC and WHO repositories provided cancer statistics and institutional reports, while reference lists and grey literature were also reviewed. Only studies published between 2010 and 2025 and that contain cervical cancer-related studies on the component of health system delays/survivor challenges in SSA and the associated survivorship were reviewed and subjected to thematic analysis.
Results: Evidence shows that in Sub-Saharan Africa, it is common for prolonged TTIs to occur during various stages of the continuum of care, including identification of symptoms, diagnosis, referral, treatment planning, and formal initiation of treatment. Main delays are caused by a combination of inadequate cancer care infrastructure, shortage of radiotherapy services, limited pathology, a large gap in the workforce, a weak referral system, financial barriers, and disparities in physical access to care. Most women present with late-stage disease, which limits the potential for curative treatment. Delays in treatment are also related to advanced disease, which is associated with decreased treatment effectiveness, increased recurrence, and poorer survival. Promising interventions to address the barriers to access, such as decentralizing oncological services, patient navigation programs, and the use of telemedicine and an increase in radiotherapy services, have potential to address these barriers.
Conclusion: Long TTIs remain a key obstacle to cervical cancer survival in SSA. Improving community-based protective structures, including treatment, referral, and diagnostic systems, skilled workforce engagement, and financial systems, will enhance timely treatment and decrease cervical cancer mortality in SSA.
Bright Odinaka Okorocha, Chigaemezu Remmy-Martin Akubuo, Abdulhafeez Opeyemi Busari et al.· IPS Journal of Basic and Cli...· 0 citations
Pakistan faces an escalating cancer burden, with approximately 185,748 new cases and 118,631 deaths annually. According to GLOBOCAN data, breast cancer (16.5%), lip/oral cavity cancer (8.6%), and lung cancer (5.1%) are the most prevalent, with breast cancer alone accounting for 31.3% of female cases. The country's limited healthcare resources, including severe shortages of oncologists and radiotherapy facilities, exacerbate this crisis, requiring urgent intervention. The delta Mortality-to-Incidence Ratio (dMIR) metric identifies cancers with the largest outcome gaps between Pakistan and top-performing countries, highlighting where improvements could yield the greatest impact. For instance, stomach cancer (dMIR = 0.60), Kaposi sarcoma (0.58), and oral cavity cancer (0.49) represent critical priorities. By focusing resources on high-dMIR cancers through early detection, treatment access, and prevention programs, Pakistan can significantly reduce preventable mortality. To address these challenges, Pakistan must implement a comprehensive National Cancer Control Plan. Key steps include expanding screening programs for breast, cervical, and oral cancers; training healthcare workers; upgrading radiotherapy infrastructure; and launching public awareness campaigns targeting tobacco use and lifestyle risks. Strategic investments in these areas, coupled with policy reforms and public-private partnerships, could transform cancer outcomes in Pakistan. Key Words: Pakistan, Cancer burden, Delta mortality-to-incidence ratio, Cancer disparities, Low- and middle-income countries.
Aashir Aslam, S. N. Zafar· Journal of the College of Ph...· 0 citations
Objectives To quantify the global, regional, and national burden of six major female cancers among adolescent and young adult (AYA) women (aged 15–39 years) in 2022, and to project incidence and mortality trends to 2050. Methods Using GLOBOCAN 2022 estimates, we analyzed incidence, mortality, age-standardized rates, cumulative risk, and mortality-to-incidence ratios (MIRs) for breast, ovarian, corpus uteri, cervical, vaginal, and vulvar cancers across 185 countries. Burden metrics were compared across geographic regions and Human Development Index (HDI) categories. Spearman correlation analyses assessed associations between HDI and cancer burden indicators. Future cancer burden through 2050 was projected based on global demographic forecasts, assuming constant 2022 age-specific incidence and mortality rates. Results Globally, an estimated 406,385 incident cases and 93,848 deaths from female cancers occurred among AYA women in 2022, corresponding to an ASIR of 24.8 and an ASMR of 5.7 per 100,000 population. Breast cancer accounted for the largest burden of both incident cases and deaths, whereas cervical cancer exhibited the highest mortality-to-incidence ratio, indicating disproportionately poor survival. Considerable geographic and socioeconomic disparities were observed. Very high-HDI countries had the highest incidence but the lowest mortality, whereas low-HDI countries experienced disproportionately high mortality and the highest MIR. HDI was positively associated with incidence (ASIR: ρ = 0.282; cumulative incidence: ρ = 0.302; both P < 0.001) but strongly inversely associated with mortality (ASMR: ρ = −0.797; cumulative mortality: ρ = −0.795) and MIR (ρ = −0.900; all P < 0.001). Assuming constant age-specific rates, incident cases are projected to increase by 13.7% and deaths by 27.7% globally by 2050, with the largest increases expected in Africa and low-HDI countries. Conclusions Female cancers impose a substantial and inequitable burden among AYA women worldwide. The projected increase in burden, particularly in low-HDI countries, highlights the urgent need to strengthen equitable cancer prevention, early detection, and treatment to reduce global disparities.
Rongbo Ding, Hong-Yan Jia· Frontiers in Oncology· 0 citations
By 2030, an estimated 75% of cancer deaths will occur in low- and middle-income countries (LMICs). Weak surveillance systems and limited research infrastructure often hide the true magnitude of this burden. Thus, independent, locally led research is essential for generating high-quality data, addressing regional disease patterns, and informing context-specific strategies for cancer control. Low national investment, heavy reliance on industry-sponsored trials, and a scarcity of trained clinician-scientists hinder independent cancer research in LMICs. In this narrative review, we synthesize the published literature and present a descriptive analysis of oncology trials registered on ClinicalTrials.gov (accessed July 2025), categorized by country, funding source, and tumor site and normalized to disease burden, drawing on illustrative examples from Africa, Asia, and Latin America. We highlight the transformative impact of context-sensitive research initiatives, explore disparities in sponsorship by country and tumor type, and outline ways to strengthen the research infrastructure. These include the establishment of population-based cancer registries, regional funding mechanisms, streamlined regulatory frameworks, and workforce development through formal research training and protected time. Finally, we propose strategies to enhance international collaboration and amplify LMIC participation in setting global cancer research priorities.
O. Arrieta, E. Rios-Garcia, Cittim B. Palomares-Palomares et al.· The Oncologist· 0 citations
Prostate cancer remains a leading cause of cancer morbidity and mortality among men globally, with the highest death rates observed in low- and middle-income countries (LMICs). Although therapeutic advances have substantially improved outcomes in high-income settings, their impact in LMICs has been limited by late presentation, diagnostic constraints, restricted access to effective treatments, and health system fragility. Metastatic prostate cancer therefore dominates clinical practice in many LMICs, necessitating context-adapted diagnostic and management strategies. This narrative review synthesizes evidence from population-level datasets, international clinical trials, observational studies, and global oncology policy literature to examine the diagnosis and management of metastatic prostate cancer in low- and middle-income countries, with particular emphasis on sub-Saharan Africa where the burden of late-stage disease and the implementation constraints are most consistently documented. Evidence was selected for clinical relevance, feasibility, and health system applicability rather than for statistical pooling. Across many LMIC settings, 40–70% of men with prostate cancer present with metastatic disease at diagnosis, contributing to five-year survival rates below 40%, compared with over 90% in many high-income countries. Diagnostic pathways are constrained by limited access to Prostate-Specific Antigen (PSA) testing, pathology services, conventional imaging, and advanced staging technologies, necessitating risk-stratified and symptom-directed approaches. In metastatic castration-sensitive prostate cancer, reliable androgen deprivation therapy remains the treatment foundation, with surgical orchiectomy offering a durable and cost-effective option where medical castration is unaffordable or unreliable. Docetaxel provides meaningful survival benefit in selected fit patients but requires minimum supportive care capacity, while access to androgen receptor pathway inhibitors remains highly variable. In metastatic castration-resistant disease, most patients depend on chemotherapy, symptom control, and palliative care. Cross-cutting barriers include financial toxicity, workforce shortages, fragmented referral pathways, and unreliable medicine supply chains. Nonetheless, implementation models from several LMICs demonstrate measurable improvements in access, continuity of care, and affordability through integrated financing, task-shifting, and centralized procurement. Outcomes for men with metastatic prostate cancer in LMICs are shaped more by health system capacity than by therapeutic efficacy alone. The evidence supports a tiered approach that prioritizes timely diagnosis, uninterrupted androgen deprivation therapy, selective treatment intensification, and accessible palliative care. Lessons from sub-Saharan Africa show that measurable gains are achievable through task-sharing, simplified referral pathways, centralized procurement, and financial protection for essential cancer services. Most prostate cancer cases in LMICs present with metastatic disease due to delayed diagnosis. Androgen deprivation therapy remains the most impactful treatment for metastatic prostate cancer in resource-limited settings. Surgical orchiectomy provides a durable, cost-effective alternative to long-term medical castration. Docetaxel and androgen receptor pathway inhibitors improve survival but remain inaccessible to many patients. Diagnostic staging in LMICs relies on risk-stratified, symptom-directed approaches rather than advanced imaging. Health system reforms improve access, continuity of care, and affordability for metastatic prostate cancer. Most prostate cancer cases in LMICs present with metastatic disease due to delayed diagnosis. Androgen deprivation therapy remains the most impactful treatment for metastatic prostate cancer in resource-limited settings. Surgical orchiectomy provides a durable, cost-effective alternative to long-term medical castration. Docetaxel and androgen receptor pathway inhibitors improve survival but remain inaccessible to many patients. Diagnostic staging in LMICs relies on risk-stratified, symptom-directed approaches rather than advanced imaging. Health system reforms improve access, continuity of care, and affordability for metastatic prostate cancer.
G. Igebu, Oluwatosin Franscica Mabadeje, Chinaza Enyinnaya-Okidi et al.· African Journal of Urology· 0 citations
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