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Global oncology and access in low- and middle-income countries

Seventy percent of cancer deaths occur in low- and middle-income countries, where radiotherapy machines, pathologists, essential medicines and palliative care are scarce. Global oncology works on affordable, adapted care and the systems to deliver it.

The Lancet Oncology Commissions (2010, 2015 radiotherapy GTFRCC, 2020 sustainable care) quantified the gaps: ~28 African countries have no radiotherapy, one pathologist per million people in parts of Africa, and cancer survival for children ~20% versus ~80% in high-income countries. Responses include the WHO Global Initiative for Childhood Cancer (2018, target 60% survival by 2030), the WHO Cervical Cancer Elimination Initiative (2020: 90-70-90 targets), the WHO Global Breast Cancer Initiative, the WHO Essential Medicines List for cancer (updated 2023-25 to include trastuzumab, PD-1 inhibitors), the Access to Oncology Medicines Coalition (ATOM, UICC/2022), pooled procurement (St Jude-WHO Global Platform for childhood cancer medicines, delivering to 50 countries from 2025), differential pricing and generic/biosimilar entry, treatment protocols adapted for resource levels (NCCN Harmonized Guidelines for Africa, SIOP PODC), twinning programmes, telepathology and AI-assisted screening, and workforce training (AORTIC, ASCO International). Rays of Hope (IAEA, 2022) targets radiotherapy expansion. Cancer is increasingly part of universal health coverage debates.

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How it works

Match the delivery system to the resource level without abandoning evidence: prioritise high-cure, low-cost interventions (cervical screening/vaccination, childhood cancer protocols, essential chemotherapy and surgery, palliative care) while building pathology, radiotherapy and workforce capacity.

Strengths
  • Large, cheap gains available (HPV vaccination, childhood ALL, Wilms, Burkitt, cervical screening)
  • Pooled procurement and biosimilars are lowering prices
  • International targets create accountability
Limitations
  • Financing and workforce shortfalls dwarf aid flows
  • Cancer under-prioritised relative to infectious disease
  • Data systems (registries) weak; late presentation common

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