# Most of the world has almost no cancer care

Source: https://onco.cc/bottlenecks/b-global-access/  
OnCo record `b-global-access` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.

## Summary

About 70% of cancer deaths occur in low- and middle-income countries, and the gap is widening as incidence shifts toward them. Dozens of countries have no radiotherapy machine at all; fewer than a quarter of patients in low-income countries who need cancer surgery can get safe, affordable, timely surgery; pathology turnaround is measured in weeks; and essential cancer medicines on the WHO list are unavailable or unaffordable in much of Africa and South Asia. The consequence is that survival for the same cancer differs more between countries than any drug has ever achieved: childhood cancer survival exceeds 80% in high-income countries and is below 30% in many low-income ones. Most of the deficit is not in frontier technology but in basic infrastructure, workforce, financing and referral systems, and in the fact that cancer control receives a small share of global health funding.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-08
- Stage: access-delivery
- Severity: critical
- Metrics: Share of cancer deaths occurring in low- and middle-income countries: ~70% (WHO fact sheet, Cancer); Childhood cancer survival in high-income vs many low- and middle-income countries: More than 80% vs less than 30% (WHO fact sheet, Cancer in children); Patients needing cancer surgery in low-income countries with access to safe, affordable, timely surgery: Less than 25% (fewer than 5% in some settings) (Sullivan et al., Lancet Oncology Commission on Global Cancer Surgery 2015); Patients in low-income countries with access to radiotherapy relative to need (2015 estimate): Under 10% (Atun et al., Lancet Oncology Commission 2015)
- Causes: Cancer control receives a small fraction of development assistance for health, which has focused on infectious disease.; Radiotherapy, pathology and surgery require capital, maintenance and trained staff that low-income systems cannot sustain.; Essential medicines are priced for high-income markets and supply chains for cold-chain biologics do not reach many countries.; Weak primary care and referral systems mean patients present late and travel far.; Out-of-pocket payment for treatment pushes families into poverty or abandonment of care.

## Sources

- WHO fact sheet, Cancer: https://www.who.int/news-room/fact-sheets/detail/cancer
- Sullivan et al., Global cancer surgery: delivering safe, affordable, and timely cancer surgery (Lancet Oncology Commission 2015): https://doi.org/10.1016/S1470-2045(15)00223-5
- Atun et al., Expanding global access to radiotherapy (Lancet Oncology Commission 2015): https://doi.org/10.1016/S1470-2045(15)00222-3
- IAEA Rays of Hope: https://www.iaea.org/services/rays-of-hope

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- institutions: [Agência Nacional de Vigilância Sanitária](https://onco.cc/institutions/anvisa/), [Cancer Hospital, Chinese Academy of Medical Sciences](https://onco.cc/institutions/cams-cancer-hospital/), [Central Drugs Standard Control Organization](https://onco.cc/institutions/cdsco/), [Comisión Federal para la Protección contra Riesgos Sanitarios](https://onco.cc/institutions/cofepris/), [European Cancer Organisation](https://onco.cc/institutions/ecco/), [European Medicines Agency](https://onco.cc/institutions/ema/), [European Society for Radiotherapy and Oncology](https://onco.cc/institutions/estro/), [Gates Foundation](https://onco.cc/institutions/gates-foundation/), [Hacettepe University Cancer Institute](https://onco.cc/institutions/hacettepe-cancer-institute/), [Haute Autorité de Santé](https://onco.cc/institutions/has-france/), [Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi](https://onco.cc/institutions/homi-bhabha-cancer-hospital-varanasi/), [Indian Institute of Technology Bombay](https://onco.cc/institutions/iit-bombay/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [International Atomic Energy Agency: Rays of Hope](https://onco.cc/institutions/iaea/), [Istanbul University Institute of Oncology](https://onco.cc/institutions/istanbul-oncology-institute/), [Li Ka Shing Foundation](https://onco.cc/institutions/li-ka-shing-foundation/), [Maria Skłodowska-Curie National Research Institute of Oncology](https://onco.cc/institutions/nio-warsaw/), [Narayana Health (Mazumdar Shaw Medical Centre)](https://onco.cc/institutions/narayana-health/), [National Cancer Grid of India](https://onco.cc/institutions/national-cancer-grid/), [National Health Authority (Ayushman Bharat PM-JAY)](https://onco.cc/institutions/nha-pmjay/), [National Healthcare Security Administration](https://onco.cc/institutions/nhsa/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [National Institute of Oncology, Hungary](https://onco.cc/institutions/noi-budapest/), [Pharmaceutical Benefits Advisory Committee](https://onco.cc/institutions/pbac/), [Pharmaceuticals and Medical Devices Agency](https://onco.cc/institutions/pmda/), [St. Jude Children's Research Hospital](https://onco.cc/institutions/st-jude/), [Sun Yat-sen University Cancer Center](https://onco.cc/institutions/sysucc/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/), [Tata Trusts](https://onco.cc/institutions/tata-trusts/), [Texas Children's Cancer and Hematology Center](https://onco.cc/institutions/texas-childrens/), [The new AIIMS network (PMSSY)](https://onco.cc/institutions/aiims-network/), [Union for International Cancer Control](https://onco.cc/institutions/uicc/), [West China Hospital, Sichuan University](https://onco.cc/institutions/west-china/), [World Health Organization Cancer Programme](https://onco.cc/institutions/who/)
- terms: [Biosimilar](https://onco.cc/terms/biosimilar/), [China Drug Administration Law (2019) and expedited pathways](https://onco.cc/terms/china-drug-administration-law/), [China National Reimbursement Drug List negotiation and volume-based procurement](https://onco.cc/terms/china-vbp-nrdl/), [EU HTA Regulation (EU) 2021/2282: joint clinical assessments](https://onco.cc/terms/eu-hta-regulation/), [EU pharmaceutical package reform (2023 proposal)](https://onco.cc/terms/eu-pharma-package/), [Expanded access (compassionate use)](https://onco.cc/terms/expanded-access/), [France: early access (accès précoce), formerly ATU](https://onco.cc/terms/france-early-access/), [Hepatitis B and C as cancer causes](https://onco.cc/terms/hbv-hcv/), [India New Drugs and Clinical Trials Rules 2019](https://onco.cc/terms/india-new-drugs-rules-2019/), [Nexavar compulsory licence (India, 2012)](https://onco.cc/terms/nexavar-compulsory-licence/), [Novartis v. Union of India (Glivec, 2013)](https://onco.cc/terms/novartis-glivec-ruling/), [Other-cause mortality](https://onco.cc/terms/other-cause-mortality/), [TRIPS Agreement and the Doha Declaration](https://onco.cc/terms/trips-doha/)
- key papers: [A National Cancer Grid pooled procurement initiative, India](https://onco.cc/key-papers/paper-pramesh-ncg-pooled-procurement-2023/), [A sarcoma involving the jaws in African children](https://onco.cc/key-papers/paper-burkitt-sarcoma-involving-jaws-african-children-br-j-surg-1958/), [Adult T-cell leukemia: antigen in an ATL cell line and detection of antibodies to the antigen in human sera](https://onco.cc/key-papers/paper-hinuma-adult-t-cell-leukaemia-antigen-pnas-1981/), [Association of Black race with prostate cancer-specific and other-cause mortality](https://onco.cc/key-papers/paper-dess-black-race-prostate-mortality-jama-oncol-2019/), [CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy](https://onco.cc/key-papers/paper-cartitude-4-cilta-cel-nejm-2023/), [Colorectal cancer statistics, 2023](https://onco.cc/key-papers/paper-siegel-colorectal-cancer-statistics-ca-2023/), [Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray](https://onco.cc/key-papers/paper-hans-immunohistochemistry-cell-of-origin-dlbcl-blood-2004/), [Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry](https://onco.cc/key-papers/paper-bauer-triple-negative-california-registry-cancer-2007/), [Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma](https://onco.cc/key-papers/paper-poiesz-htlv-retrovirus-cutaneous-t-cell-lymphoma-pnas-1980/), [ELIANA: the global trial that made tisagenlecleucel the first approved CAR-T therapy for children and young adults with relapsed ALL](https://onco.cc/key-papers/paper-eliana-tisagenlecleucel-nejm-2018/), [England's HPV programme: cervical cancer down 87% in the first cohort vaccinated at 12-13](https://onco.cc/key-papers/paper-hpv-vaccine-england-lancet-2021/), [Epidemiology of gallbladder cancer in India](https://onco.cc/key-papers/paper-dutta-gallbladder-cancer-epidemiology-india-chin-clin-oncol-2019/), [Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers](https://onco.cc/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/), [Expanding global access to radiotherapy](https://onco.cc/key-papers/paper-atun-lancet-oncol/), [FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer](https://onco.cc/key-papers/paper-flaura-nejm-2018/), [Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2)](https://onco.cc/key-papers/paper-dasari-fresco-2-fruquintinib-lancet-2023/), [Global cancer surgery: delivering safe, affordable, and timely cancer surgery](https://onco.cc/key-papers/paper-sullivan-lancet-oncol/), [Hospital-based gallbladder cancer registry from a high-volume referral cancer centre in India: Insights into epidemiology and roadmap for enhancing cancer care](https://onco.cc/key-papers/paper-patkar-tata-memorial-gallbladder-cancer-registry-cancer-epidemiol-2025/), [IMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer](https://onco.cc/key-papers/paper-imbrave150-nejm-2020/), [IRIS: imatinib versus interferon plus cytarabine as first treatment for chronic myeloid leukaemia](https://onco.cc/key-papers/paper-iris-imatinib-nejm-2003/), [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (overall survival)](https://onco.cc/key-papers/paper-keynote-a18-os-lancet-2024/), [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (progression-free survival)](https://onco.cc/key-papers/paper-keynote-a18-pfs-lancet-2024/), [NETTER-2: lutetium-177 dotatate as first treatment for higher-grade gastroenteropancreatic neuroendocrine tumours](https://onco.cc/key-papers/paper-netter-2-lancet-2024/), [Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study](https://onco.cc/key-papers/paper-smile-chemotherapy-nk-t-cell-lymphoma-jco-2011/), [Safety and efficacy of odronextamab in patients with relapsed or refractory follicular lymphoma](https://onco.cc/key-papers/paper-elm-2-odronextamab-follicular-ann-oncol-2024/), [Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement](https://onco.cc/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/), [Self-collected HPV samples are as accurate as clinician samples and reach women who never attend screening](https://onco.cc/key-papers/paper-hpv-self-sampling-bmj-2018/), [Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies](https://onco.cc/key-papers/paper-peto-smoking-cessation-lung-cancer-uk-bmj-2000/), [Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis](https://onco.cc/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/), [Swedish registry study: HPV vaccination almost eliminates cervical cancer when given before 17](https://onco.cc/key-papers/paper-hpv-vaccine-sweden-nejm-2020/), [Talicabtagene autoleucel for relapsed or refractory B-cell malignancies: an open-label, multicentre, phase 1/2 study](https://onco.cc/key-papers/paper-jain-talicabtagene-lancet-haem-2025/), [Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: the phase 2 ELARA trial](https://onco.cc/key-papers/paper-elara-tisagenlecleucel-follicular-nat-med-2022/), [Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction](https://onco.cc/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/), [Update on triple-negative breast cancer disparities for the United States: A population-based study from the United States Cancer Statistics database, 2010 through 2014](https://onco.cc/key-papers/paper-scott-tnbc-disparities-uscs-cancer-2019/), [VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801](https://onco.cc/key-papers/paper-jcog9801-vcap-amp-vecp-adult-t-cell-leukaemia-jco-2007/), [Virus particles in cultured lymphoblasts from Burkitt's lymphoma](https://onco.cc/key-papers/paper-epstein-virus-particles-burkitt-lymphoblasts-lancet-1964/), [VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer](https://onco.cc/key-papers/paper-vision-nejm-2021/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)
- journals: [Journal of cancer policy](https://onco.cc/journals/journal-of-cancer-policy/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants](https://onco.cc/roadmaps/devices-roadmap/), [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/), [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/), [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)
- trials: [ELARA](https://onco.cc/trials/elara/), [FORTplus](https://onco.cc/trials/fortplus/), [Gefitinib vs gefitinib plus pemetrexed-carboplatin in EGFR-mutant lung cancer (Tata Memorial)](https://onco.cc/trials/gefitinib-chemo-tmh/), [IARC India HPV vaccine dose study (one, two or three doses)](https://onco.cc/trials/iarc-india-hpv-dose-study/), [IMAGINE (varnimcabtagene autoleucel, Immuneel)](https://onco.cc/trials/imagine-varnimcabtagene/), [JCOG9801](https://onco.cc/trials/jcog9801/), [JULIET](https://onco.cc/trials/juliet/), [Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial)](https://onco.cc/trials/low-dose-nivolumab-tmh/), [Low-dose olanzapine for cancer anorexia (Tata Memorial)](https://onco.cc/trials/olanzapine-appetite-tmh/), [METRO PLUS (Tata Memorial Centre, Varanasi)](https://onco.cc/trials/metro-plus-varanasi/), [Mumbai VIA cervical screening trial (Tata Memorial)](https://onco.cc/trials/mumbai-via-screening/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/), [Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)](https://onco.cc/trials/osmanabad-hpv-screening/), [SMILE](https://onco.cc/trials/smile-enktl/), [Talicabtagene autoleucel (NexCAR19) phase 1/2](https://onco.cc/trials/talicel-phase-1-2/)
- people: [Bill Gates](https://onco.cc/people/bill-gates/), [C. S. Pramesh](https://onco.cc/people/pramesh-c-s/), [Devi Shetty](https://onco.cc/people/shetty-devi/), [Goh Cheng Liang](https://onco.cc/people/goh-cheng-liang/), [Ian Frazer](https://onco.cc/people/ian-frazer/), [Kiran Mazumdar-Shaw](https://onco.cc/people/mazumdar-shaw-kiran/), [Li Ka-shing](https://onco.cc/people/li-ka-shing/), [Lucille P. Markey](https://onco.cc/people/lucille-markey/), [Rahul Purwar](https://onco.cc/people/purwar-rahul/), [Ratan Tata](https://onco.cc/people/ratan-tata/), [Robert W. Woodruff](https://onco.cc/people/robert-woodruff/), [Sir Dorabji Tata](https://onco.cc/people/dorabji-tata/)
- companies: [Biocon](https://onco.cc/companies/biocon/), [Biocon Biologics](https://onco.cc/companies/biocon-biologics/), [Cipla](https://onco.cc/companies/cipla/), [Dr. Reddy's Laboratories](https://onco.cc/companies/dr-reddys/), [Hetero Drugs](https://onco.cc/companies/hetero/), [Immuneel Therapeutics](https://onco.cc/companies/immuneel/), [ImmunoACT](https://onco.cc/companies/immunoact/), [Natco Pharma](https://onco.cc/companies/natco/), [Serum Institute of India](https://onco.cc/companies/serum-institute-of-india/)

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JSON: https://onco.cc/api/v1/entities/b-global-access.json