Gynecologic cancers in low- and middle-income countries: Bridging the survival gap.

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.