The global burden of cancer is rising, with low- and middle-income countries (LMICs), particularly in SSA, bearing an increasing share¹. While cancer incidence in SSA is currently lower than in high-income regions, mortality rates are significantly higher, reflecting profound disparities in access to timely diagnosis and effective treatment^2,3. Projections indicate a near doubling of cancer incidence in Africa by 2040, driven by demographic changes, urbanisation, and lifestyle shifts⁴. The rising burden threatens fragile health systems already strained by infectious diseases. Effective cancer diagnosis and management are paramount for improving survival and quality of life.

The objective of this review is to provide a comprehensive overview of the current state of cancer care in SSA, focusing on epidemiology, diagnostic and therapeutic capabilities, systemic challenges, ongoing initiatives, research gaps, and future directions, with a focus on evidence from the past decade.

Epidemiological Overview

Cancer incidence and mortality in SSA exhibit distinct patterns. Common cancers include infection-associated malignancies like cervical (caused by HPV), liver (associated with HBV/HCV), and Kaposi sarcoma (HHV-8), alongside breast and prostate cancers^5,6. Age-standardised incidence rates (ASIRs) for cervical cancer in SSA are among the highest globally, while prostate cancer incidence and mortality are rising rapidly,^7.8. Breast cancer, often presenting at younger ages and more advanced stages than in high-income countries, is a leading cause of cancer death among women ⁹. Significant regional disparities exist; East Africa has high rates of Oesophageal cancer, while Southern Africa reports higher rates of lung and colorectal cancers^10,11. Late-stage diagnosis is pervasive, contributing to mortality rates often exceeding 70% for many common cancers, compared to less than 50% in high-resource settings^11,12. Cancer registries, essential for planning, remain sparse and under-resourced, leading to significant underestimation of the true burden¹⁴ (Figure 1)

Data are based on recent estimates from GLOBOCAN 2020 and peer-reviewed studies comparing West African and global cancer indicators, including late-stage presentation rates, 5-year survival outcomes, and cervical cancer screening coverage. Values are approximate averages derived from regional studies and WHO/IAEA reports.

Current Diagnostic Landscape

Diagnostic Modalities: Access to essential diagnostic tools is severely limited. Basic imaging (X-ray, ultrasound) is more available. Still, access to computed tomography (CT) is restricted, and magnetic resonance imaging (MRI) and positron emission tomography (PET) are scarce outside major referral centres ^15,16. Histopathology services are centralized in urban areas; immune histochemistry (IHC), crucial for subtype classification (e.g., breast cancer), is often unavailable or unreliable¹⁷. Tumour marker testing (e.g., PSA, CA-125) is inconsistently accessible. Molecular diagnostics (PCR, next-generation sequencing – NGS) and liquid biopsies remain largely confined to research settings or a few specialised laboratories due to cost, infrastructure requirements, and lack of expertise^18,19.

Access and Utilisation: A stark urban-rural divide exists. Rural populations face immense barriers, including distance to facilities, transportation costs, and lack of awareness ²⁰. Delayed presentation is a critical issue, driven by low health literacy, cultural beliefs, fear, stigma, and reliance on traditional medicine²¹. Consequently, 60-80% of patients present with advanced (Stage III/IV) disease ²². Cost remains a prohibitive factor for many diagnostics, compounded by insufficient infrastructure (reliable electricity, water) and critical shortages of trained personnel (pathologists, radiologists, radiographers, laboratory technicians) ^23,24 (Figure 2).

Values are illustrative averages based on estimates from GLOBOCAN 2020, WHO Global Health Observatory, and recent peer-reviewed studies on diagnostic capacity in West Africa compared with high-income countries. Indicators include pathologist density, imaging availability, access to molecular diagnostics, and average diagnostic delays.

Cancer Treatment Modalities:

Surgery: Surgical oncology services are concentrated in tertiary centres. While essential for solid tumours, access is limited by shortages of trained surgical oncologists, anesthesiologists, operating theatre capacity, inadequate postoperative care, and blood bank deficiencies ^25,26. Safety and quality standards vary considerably.

Radiotherapy: Radiotherapy, required for approximately 50% of cancer patients, is severely under-resourced. Many SSA countries lack any radiotherapy facilities; the region has less than 10% of the needed machines^27,28. Existing centres face chronic challenges: machine breakdowns due to ageing equipment, lack of maintenance engineers, power fluctuations, shortages of radioisotopes, and insufficient medical physicists and radiation therapists^29,30. This results in long waiting times and compromised treatment schedules.

Chemotherapy: Access to essential cytotoxic drugs is inconsistent. Affordability is a major barrier, exacerbated by importation costs, taxes, and mark-ups³¹. Supply chain weaknesses lead to stockouts, while concerns about drug quality and counterfeit products persist³². Supportive care drugs (e.g., anti-emetics, growth factors) are often unavailable or unaffordable³³.

Targeted and Immunotherapies: Access to targeted therapies (e.g., trastuzumab for HER2+ breast cancer) and immunotherapies is scarce outside of private practice or specific research/compassionate use programs due to exorbitant costs (often exceeding annual incomes) and infrastructure demands for administration and monitoring^34,35. Participation in global clinical trials offering newer agents is limited³⁶.

Palliative Care: Integration of palliative care into national health systems is inadequate. Regulatory barriers, inadequate training, and misconceptions about opioid use^37,38 severely restrict access to oral morphine and other essential pain relief medications. Holistic end-of-life care services are scarce, especially outside major cities³⁹ (Figure 3).

Values reflect estimated access to key cancer treatment modalities in West Africa relative to global benchmarks (100%). Data are based on the WHO Global Health Observatory, IAEA radiotherapy reports, and regional studies on chemotherapy and palliative care availability. The “gap” segment highlights the shortfall compared to international standards.

Health System Challenges:

The delivery of cancer care by SSA nations is hindered by inherent shortcomings within the health system.

Labour Deficiencies: Severe shortage of qualified oncology professionals, including medical, clinical, and radiation oncologists, pathologists, radiologists, oncology nurses, chemists, and allied health personnel. The emigration of skilled individuals to high-income nations exacerbates capacity depletion ^40,41. 

Insufficient infrastructure: Insufficient facilities, inconsistent power and water supply, inadequate sanitation, and limited maintenance capabilities hinder service delivery ⁴².

Fragmented referral pathways result in unclear, ineffective systems that cause delays, duplication, and patient loss to follow-up⁴³. 

Financial obstacles: Significant out-of-pocket costs for diagnosis and treatment are disastrous for numerous families. The absence of universal health coverage (UHC) or insufficient integration of cancer services into health insurance plans constitutes a significant barrier ^44,45.

Inadequate Data Systems: Population-based cancer registries encompass only a limited segment of the population. The absence of comprehensive data impedes planning, resource distribution, and progress assessment ^46,47(Table 1).

Ongoing Initiatives and Innovations:

Efforts are underway to address the cancer burden: National Cancer Control Programs (NCCPs): Numerous SSA nations have formulated NCCPs; nevertheless, execution and financing continue to pose significant obstacles ⁴⁸.

Public-Private Partnerships (PPPs) & International Support: Partnerships with NGOs (e.g., African Organisation for Research and Training in Cancer – AORTIC), international agencies (WHO, IAEA Programmed of Action for Cancer Therapy – PACT, Union for International Cancer Control – UICC), and private entities aim to build capacity, provide equipment, and support training^49,50.

The IAEA has been instrumental in supporting radiotherapy centres⁵¹.

Innovations: Mobile health units for screening, such as cervical cancer using VIA, telepathology/tele-radiology consultations, and tele-oncology for specialist advice, are being piloted to bridge geographic gaps^52,53.

Centres of Excellence: Establishment of regional centres (e.g., Butaro Cancer Centre in Rwanda, Uganda Cancer Institute, Inkosi Albert Luthuli Central Hospital in South Africa) aims to provide comprehensive care and training hubs^54,55.

Research Gaps and Future Directions:

Significant research gaps hinder progress:

Local Data: Need for high-quality, population-specific epidemiological, genomic, and clinical outcomes data to inform tailored interventions⁵⁶.

Implementation Research findings: Research on effective models for delivering affordable, scalable cancer care in resource-constrained settings is crucial⁵⁷.

Capacity Building: Investment in training African cancer researchers and strengthening local research institutions is essential⁵⁸.

Clinical Trials Inclusion: Strategies to increase SSA participation in global clinical trials, ensuring relevance of new therapies to the regional context⁵⁹.

Prevention and Early Detection: Prioritising research and implementation of cost-effective prevention (vaccination – HPV, HBV) and early detection strategies (e.g., screening for cervical, breast, colorectal cancers)^60,61.

Survivorship: Understanding and addressing the unique needs of cancer survivors in SSA is an emerging priority⁶².

Recommendations:

Addressing the cancer crisis in SSA requires multi-faceted, sustained action:

Enhance Data Systems – Invest in and expand high-quality, population-based cancer registries for precise burden assessment and monitoring⁶³.

Expand Access to Diagnostics: Scale up essential diagnostics (ultrasound, basic pathology, strategically placed CT) through innovative financing, task-shifting, and public-private partnerships. Prioritise reliable supply chains for reagents and consumables⁶⁴.

Improve Treatment Access: Increase radiotherapy capacity through strategic planning, sustainable financing, and international support (e.g., IAEA). Ensure a reliable supply and affordability of essential chemotherapy drugs. Explore mechanisms for sustainable access to select targeted therapies where clinically impactful ^65,66l.

Build and Retain Workforce: Substantially increase investment in training surgical oncologists, oncologists, pathologists, radiologists, oncology nurses, and allied health professionals. Implement strategies for retention, including competitive remuneration and career development opportunities. Utilise task-shifting/sharing where appropriate and safe^67,68.

Enhance Palliative Care: Integrate palliative care into national health policies and NCCPs. Remove regulatory barriers to opioid access and train healthcare workers in pain management and palliative care⁶⁹.

Foster Regional Collaboration: Promote knowledge sharing, resource pooling (e.g., specialist training, rare diagnostic tests), and harmonised policies across SSA countries. Strengthen regional bodies like AORTIC⁷⁰.

Integrate Cancer into UHC and SDGs: Prioritise inclusion of essential cancer prevention, diagnosis, treatment, and palliative care services within national UHC benefit packages, aligned with Sustainable Development Goal (SDG) 3.4 on reducing premature NCD mortality^71,72.

Prioritise Prevention and Early Detection: Scale up HPV and HBV vaccination. Implement and evaluate context-appropriate, cost-effective screening programs for cervical, breast, and other high-burden cancers. Invest in public awareness campaigns^73,74.

Conclusion:

Cancer diagnosis and management in Sub-Saharan Africa face severe challenges, including weak health systems, limited infrastructure, workforce shortages, inadequate access to medicines and technologies, and late-stage presentations, all driving high mortality. Although progress has been made through national cancer control plans, innovations, and international collaborations, urgent and sustained investment is needed. Achieving equitable cancer care will require Africa-led strategies, stronger health systems, an expanded oncology workforce, functional registries, and integration of cancer services into universal health coverage to prevent devastating human and economic consequences.

Conflict of interest: none

Source Funding: none

Acknowledgement:

We express our gratitude to the university administration and the College of Health Sciences for granting us access to its library resources.

References:

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. doi:10.3322/caac.21660.
2. Jedy-Agba E, McCormack V, Adebamowo C, Dos-Santos-Silva I. Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(12): e923–35. doi:10.1016/S2214-109X (16)30259-5.
3. Parkin DM, Bray F, Ferlay J, Jemal A. Cancer in Africa 2012. Cancer Epidemiol Biomarkers Prev. 2014;23(6):953–66. doi: 10.1158/1055-9965.EPI-14-0281.
4. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al.Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; 2024. Available from: https://gco.iarc.fr/today. [Accessed 2025 Jul 10].
5. Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al.Human Papillomavirus and Related Diseases Report. Africa. ICO/IARC Information Centre on HPV and Cancer; 2023.
6. McCormack V, Schüz J. Africa’s growing cancer burden: environmental and occupational contributions. Cancer Epidemiol. 2012;36(1):1–7. doi: 10.1016/j.canep.2011.09.005.
7. Dozie UW, Elebari BL, Nwaokoro CJ, Iwuoha GN, Emerole CO, Akawi AJ, Chukwuocha UM, Dozie INS. Knowledge, attitude and perception on cervical cancer screening among women attending the ante-natal clinic in Owerri West L.G.A, South-Eastern Nigeria: A cross-sectional study. Cancer Treat Res Commun. 2021; 28:100392. doi: 10.1016/j.ctarc.2021.100392. Epub 2021 May 13. PMID: 34023770.
8. Hsing AW, Yeboah E, Biritwum R, Tettey Y, De Marzo AM, Netto GJ, et al. High prevalence of screen-detected prostate cancer in West African men: evidence from the Ghana Prostate Study. Cancer Epidemiol Biomarkers Prev. 2015;24(10):1484–90. doi: 10.1158/1055-9965.EPI-15-0301.
9. Galukande M, Wabinga H, Mirembe F, Karamagi C, Asea A. Molecular breast cancer subtypes prevalence in an indigenous Sub-Saharan African population. Pan Afr Med J. 2014; 17:249. doi:10.11604/pamj.2014.17.249.3300.
10. McCormack VA, Menya D, Munishi MO, Dzamalala C, Gasmelseed N, Tenge C, et al. Informing etiologic research priorities for squamous cell oesophageal cancer in Africa: a review of setting-specific exposures to known and putative risk factors. Int J Cancer. 2017;140(2):259–71. doi:10.1002/ijc.. 30292.
11. Somdyala NI, Bradshaw D, Gelderblom WC, Parkin DM. Cancer incidence in a rural population of South Africa, 1998–2002. Int J Cancer. 2010;127(10):2420–9. doi:10.1002/ijc. 25246.
12. Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, et al. Improvement of pathology in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e152–7. doi:10.1016/S1470-2045(12)70598-3.
13. Moodley J, Constant D, Mwaka AD, Scott SE, Walter FM. Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa. PLoS One. 2020;15(10): e0240788. doi: 10.1371/journal.pone.0240788.
14. Parkin DM, Bray F. Evaluation of data quality in the cancer registry: principles and methods. Part II. Completeness. Eur J Cancer. 2009;45(5):756–64. doi: 10.1016/j.ejca.2008.11.033.
15. Abdel-Wahab M, Bourque JM, Pynda Y, Iżewska J, Van Der Merwe D, Zubizarreta EH, et al.Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013;14(4): e168–75. doi:10.1016/S1470-2045(12)70532-6.
16. Elmore SN, Grover S, Bourque JM, Pugh S, Iżewska J, Abdel-Wahab M, et al. Global access to radiotherapy services: Have we made progress during the past decade? J Glob Oncol. 2016;2(4):207–15. doi:10.1200/JGO.2015.001545.
17. Sayed S, Lukande R, Fleming KA.Providing pathology support in low-income countries. J Glob Oncol. 2015;1(1):3–6. doi:10.1200/JGO.2015.000943.
18. Rebbeck TR. Prostate cancer disparities by race and ethnicity: from nucleotide to neighbourhood. Cold Spring Harb Perspect Med. 2018;8(9):a030387. doi:10.1101/cshperspect. a030387.
19. Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, et al. Improvement of pathology in sub-Saharan Africa. Lancet Oncol. 2013;14(4): e152–7. doi:10.1016/S1470-2045(12)70598-3. (Relevant for molecular limitations).
20. Pace LE, Mpunga T, Hategekimana V, Dusengimana JM, Habineza H, Bigirimana JB, et al. Delays in breast cancer presentation and diagnosis at two rural cancer referral centres in Rwanda. Oncologist. 2015;20(7):780–8. doi:10.1634/theoncologist 2014-0493.
21. Moodley J, Constant D, Mwaka AD, Scott SE, Walter FM. Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa. PLoS One. 2020;15(10): e0240788. doi: 10.1371/journal.pone.0240788.
22. Jedy-Agba E, McCormack V, Adebamowo C, Dos-Santos-Silva I. Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(12): e923–35. doi:10.1016/S2214-109X (16)30259-5.
23. Elmore SN, Grover S, Bourque JM, Pugh S, Iżewska J, Abdel-Wahab M, et al. Global access to radiotherapy services: Have we made progress during the past decade? J Glob Oncol. 2016;2(4):207–15. doi:10.1200/JGO.2015.001545. (Workforce component).
24. Vanderpuye V, Grover S, Hammad N, Simonds H, Olopade F, Stefan DC, et al.An update on the management of breast cancer in Africa. Infectious Agent Cancer. 2017; 12:13. doi:10.1186/s13027-017-0124-y.
25. Galukande M, Kiguli-Malwadde E. Surgical management of breast cancer in Africa. Memphis Med J. 2012;87(1):23–5. (Link not standard, but content relevant).
26. Knowlton LM, Chackungal S, Dahn B, Rode H, Maine R, Mkandawire N, et al. Liberian surgical and anaesthesia infrastructure: a survey of county hospitals. World J Surg. 2013;37(4):721–9. doi:10.1007/s00268-013-1919-7.
27. Abdel-Wahab M, Bourque JM, Pynda Y, Iżewska J, Van Der Merwe D, Zubizarreta EH, et al.Status of radiotherapy resources in Africa: An International Atomic Energy Agency analysis. Lancet Oncol. 2013;14(4): e168–75. doi:10.1016/S1470-2045(12)70532-6.
28. Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle-income countries – the silent crisis continues. Clin Oncol (R Coll Radiol). 2015;27(2):107–14. doi: 10.1016/j.clon.2014.10.006.
29. Grover S, Xu MJ, Yeager A, Rosman L, Groen RS, Chackungal S, et al. A systematic review of radiotherapy capacity in low- and middle-income countries. Front Oncol. 2015; 4:380. doi:10.3389/fonc.. 2014.00380.
30. Datta NR, Samiei M, Bodis S. Radiation therapy infrastructure and human resources in low- and middle-income countries: present status and projections for 2020. Int J Radiat Oncol Biol Phys. 2014;89(3):448–57. doi: 10.1016/j.ijrobp.2014.03.002.
31. Robertson J, Barr R, Shulman LN, Forte GB, Magrini N. Essential medicines for cancer: WHO recommendations and national priorities. Bull World Health Organ. 2016;94(10):735–42. doi:10.2471/BLT.15.163998.
32. Mackey TK, Cuomo RE, Liang BA. The emerging global health crisis of counterfeit drugs: a call for action. Am J Trop Med Hyg. 2015;92(6 Suppl):1–4. doi:10.4269/ajtmh 15-0006e.
33. Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 2015;16(11):1193–224. doi:10.1016/S1470-2045(15)00223-5.
34. Vanderpuye V, Grover S, Hammad N, Simonds H, Olopade F, Stefan DC, et al.An update on the management of breast cancer in Africa. Infectious Agent Cancer. 2017; 12:13. doi:10.1186/s13027-017-0124-y.
35. Aminkeng F. Cancer genomic medicine in Africa: prospects and challenges. OMICS. 2018;22(6):395–9. doi:10.1089/omi.2018.0039.
36. Denny L, Anorlu R. Cervical cancer in Africa. Cancer Epidemiol Biomarkers Prev. 2012;21(9):1434–8. doi: 10.1158/1055-9965.EPI-12-0334. (Trials context).
37. Harding R, Powell RA, Kiyange F, Downing J, Mwangi-Powell F. Provision of pain- and symptom-relieving drugs for HIV/AIDS in sub-Saharan Africa. J Pain Symptom Manage. 2010;40(3):405–15. doi: 10.1016/j.jpainsymman.2009.12.025.
38. Rhee JY, Garralda E, Namisango E, Luyirika E, Powell RA, Radbruch L, et al. Factors affecting palliative care development in Africa: in-country experts’ perceptions in seven countries. J Pain Symptom Manage. 2018;55(5):1313–20. e2. doi: 10.1016/j.jpainsymman.2018.01.009.
39. Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, et al. Children’s palliative care in low- and middle-income countries. Arch Dis Child. 2016;101(1):85–90. doi:10.1136/archdischild-2015-308307.
40. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58. doi:10.1016/S0140-6736(10)61854-5.
41. Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. Lancet. 2018;391(10133):1927–38. doi:10.1016/S0140-6736(18)30458-6.
42. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–252. doi:10.1016/S2214-109X(18)30386-3.
43. Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, et al. Changing global policy to deliver safe, equitable, and affordable care for women’s cancers. Lancet. 2017;389(10071):871–80. doi:10.1016/S0140-6736(16)31393-9.
44. Carrin G, James C, Evans D. Achieving universal health coverage: developing the health financing system. World Health Organ Tech Rep Ser.. 2005;(1):1–78. (Relevant report series. See also recent country-specific UHC monitoring reports.)
45. Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, et al. Improving the responsiveness of health systems to non-communicable diseases. Lancet. 2013;381(9867):690–7. doi:10.1016/S0140-6736(12)61856-0.
46. Parkin DM, Bray F. Evaluation of data quality in the cancer registry: principles and methods. Part II. Completeness. Eur J Cancer. 2009;45(5):756–64. doi: 10.1016/j.ejca.2008.11.033.
47. Somdyala NI, Parkin DM, Sithole N, Bradshaw D. Trends in cancer incidence in rural Eastern Cape Province, South Africa, 1998–2012. Int J Cancer. 2015;136(5):E470–4. doi:10.1002/ijc.. 29224.
48. Dye TD, Bogale S, Hobden C, Tilahun Y, Hecht R, Shiferaw M, et al. Complex care systems in developing countries: breast cancer patient navigation in Ethiopia. Cancer. 2010;116(3):577–85. doi:10.1002/cncr.24776. (NCCP context).
49. Stefan DC, Elzawawy AM, Khaled HM, Rossi D, Beral C, Asuzu C, et al. Developing cancer control plans in Africa: examples from five countries. Lancet Oncol. 2013;14(4):e189–95. doi:10.1016/S1470-2045(13)70063-2.
50. Ngoma T. World Health Organisation cancer priorities in developing countries. Ann Oncol. 2006;17 Suppl 8: viii9–14. doi:10.1093/annonc/mdl982. (IAEA PACT under the WHO umbrella).
51. Abdel-Wahab M, Zubizarreta E. Advancing radiation oncology in low- and middle-income countries through IAEA support. Semin Radiat Oncol. 2017;27(2):149–57. doi: 10.1016/j.semradonc.2016.11.008.
52. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. doi:10.1016/S0140-6736(15)60160-X. (Includes mobile tech).
53. Wootton R, Patil NG, Scott RE, Ho K. Telehealth in the Developing World. London: Royal Society of Medicine Press; 2009. (Foundational principles apply.)
54. Shulman LN, Mpunga T, Tapela N, Nsanzimana S, Muvugabigwi G, Andrade L, et al. Bringing cancer care to the poor: experiences from Rwanda. Nat Rev Cancer. 2014;14(12):815–21. doi:10.1038/nrc3848.
55. Gopal S, Wood WA. Financing and delivery of cancer care in the developing world. Hematol Oncol Clin North Am. 2016;30(4):897–910. doi: 10.1016/j.hoc.2016.03.011. (Centres of Excellence context).
56. Rebbeck TR. Prostate cancer disparities by race and ethnicity: from nucleotide to neighbourhood. Cold Spring Harb Perspect Med. 2018;8(9):a030387. doi:10.1101/cshperspect. a030387. (Highlights genomic data gap).
57. Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, et al. Changing global policy to deliver safe, equitable, and affordable care for women’s cancers. Lancet. 2017;389(10071):871–80. doi:10.1016/S0140-6736(16)31393-9.
58. Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, et al. Improvement of pathology in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e152–7. doi:10.1016/S1470-2045(12)70598-3. (Research capacity component).
59. Denny L, Anorlu R. Cervical cancer in Africa. Cancer Epidemiol Biomarkers Prev. 2012;21(9):1434–8. doi: 10.1158/1055-9965.EPI-12-0334. (Trials inclusion).
60. Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al.Human Papillomavirus and Related Diseases Report. Africa. Barcelona: ICO/IARC Information Centre on HPV and Cancer; 2023.
61. Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, et al. Changing global policy to deliver safe, equitable, and affordable care for women’s cancers. Lancet. 2017;389(10071):871–80. doi:10.1016/S0140-6736(16)31393-9. (Prevention/Early.
62. Nurgalieva Z, O’Neill C. Cancer survivorship in low- and middle-income countries: a scoping review. Ecancermedicalscience. 2021; 15:1239. doi:10.3332/ecancer 2021.1239
63. Parkin DM, Bray F. Evaluation of data quality in the cancer registry: principles and methods. Part II. Completeness. Eur J Cancer. 2009;45(5):756–64. doi: 10.1016/j.ejca.2008.11.033.
64. Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. Lancet. 2018;391(10133):1927–38. doi:10.1016/S0140-6736(18)30458-6.
65. Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle-income countries – the silent crisis continues. Clin Oncol (R Coll Radiol). 2015;27(2):107–14. doi: 10.1016/j.clon.2014.10.006.
66. Robertson J, Barr R, Shulman LN, Forte GB, Magrini N. Essential medicines for cancer: WHO recommendations and national priorities. Bull World Health Organ. 2016;94(10):735–42. doi:10.2471/BLT.15.163998.
67. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58. doi:10.1016/S0140-6736(10)61854-5.
68. Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa: a desk review. Hum Resour Health. 2004;2(1):7. doi:10.1186/1478-4491-2-7.
69. Rhee JY, Garralda E, Namisango E, Luyirika E, Powell RA, Radbruch L, et al. Factors affecting palliative care development in Africa: in-country experts’ perceptions in seven countries. J Pain Symptom Manage. 2018;55(5):1313–20. e2. doi: 10.1016/j.jpainsymman.2018.01.009.
70. Stefan DC, Elzawawy AM, Khaled HM, Rossi D, Beral C, Asuzu C, et al. Developing cancer control plans in Africa: examples from five countries. Lancet Oncol. 2013;14(4):e189–95. doi:10.1016/S1470-2045(13)70063-2. (Collaboration).
71. Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, et al. Improving the responsiveness of health systems to non-communicable diseases. Lancet. 2013;381(9867):690–7. doi:10.1016/S0140-6736(12)61856-0.
72. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–252. doi:10.1016/S2214-109X(18)30386-3.
73. Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al.Human Papillomavirus and Related Diseases Report. Africa. Barcelona: ICO/IARC Information Centre on HPV and Cancer; 2023.
74. Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, et al. Changing global policy to deliver safe, equitable, and affordable care for women’s cancers. Lancet. 2017;389(10071):871–80. doi:10.1016/S0140-6736(16)31393-9. (Prevention/Early Detection).