Cancer does not respect borders: The case for Global Oncology as a global health priority

Global oncology

Every two seconds, someone receives a cancer diagnosis. Every four seconds, a life is lost to the disease. According to the Global Burden of Disease Study 2023, there were 18.5 million new cancer cases and 10.4 million deaths worldwide, resulting in 271 million disability-adjusted life-years lost. [1] Today, cancer is one of the world’s leading causes of death, and its burden is rising rapidly. If current trends continue, the number of new cases will rise to 35.3 million annually by 2050, a staggering increase of 77% while mortality is expected to almost double. Despite this, cancer remains underrepresented in global health discourse compared with infectious diseases or maternal health. It is still often perceived — in our opinion incorrectly — as a disease of affluence affecting well-resourced countries. Oncology is seen as complex and expensive, beyond reach for many settings. This perception is not only outdated; it is harmful. The regions that will face the largest increases in cancer burden are those least prepared to respond. Global oncology is a field of research and practice that addresses cancer across diverse settings, with the aim of improving outcomes through equitable access to prevention, diagnosis, and treatment. It encompasses disparities not only between countries of differing resource levels but also within health systems, where structural, socioeconomic, and cultural barriers—including language—continue to shape access to and quality of care.

Where the burden falls

More than half of all new cancer cases and nearly two-thirds of cancer deaths occur in low- and middle-income countries (LMICs).[1] This disparity is largely driven by inequities in access to care. Patients in LMICs are far more likely to be diagnosed at advanced stages and to face barriers including limited access to medicines, high out-of-pocket costs, and shortages of specialised services. The gap is widening, driven by the rapid rise in cancer burden outpacing health system capacity, alongside the uneven adoption of advances in cancer care due to high costs, limited infrastructure, and persistent underinvestment. Populations with the greatest need receive the least care — a stark global equity failure.[2] Cancer surgery and cancer pathology illustrates this clearly: safe and timely surgical care remains inaccessible for many, although it is essential for most solid tumours. Workforce shortages, limited anaesthesia capacity, and fragile infrastructure are central barriers. [3] Timely and accurate oncological pathology diagnosis are equally essential, yet scarcely available in many LMICs.

Gynaecological cancers as a lens on global inequities

Gynaecological cancers highlight these inequities vividly. In 2022, cancers of the cervix, uterus, ovaries, vagina, and vulva accounted for approximately 1.4 million new cases and over 600,000 deaths globally. [4] Most of these deaths occurred in LMICs. As an example, cervical cancer is largely preventable through Human Papilloma Virus (HPV) vaccination and screening, and highly treatable when detected early. Yet it remains a leading cause of cancer death among women in sub-Saharan Africa and South Asia. In high-income countries, it has become relatively rare, whereas in LMICs, women often present with advanced disease. This is not a failure of medical knowledge. The tools exist — we have the means to eliminate cervical cancer. It is a clear example of failure of access, implementation, and political prioritisation. We conducted a global survey of more than 1,000 gynaecological oncologists across 115 countries and identified five key barriers to optimal ovarian cancer care: societal factors, inadequate hospital resources, economic constraints, fragmented care organisation, and limited early detection capacity.[6] Advances in diagnostic procedures, pathology, surgery, targeted therapies, and immunotherapy are addressing these constraints and transforming outcomes in high-income settings, but they remain inaccessible to most patients globally.[5] 

The research gap: what we study — and for whom

Clinical inequities are reinforced by disparities in research. Cancer research remains concentrated in high-income countries, with limited focus on LMIC contexts.[7] This creates a self-reinforcing cycle: the populations most affected by cancer are least represented in the evidence base guiding care.

Addressing this imbalance requires a shift in priorities, such as improving access to screening and diagnostic facilities, improving affordability, improving quality of treatment, developing value-based care models relevant to LMICs and strengthening implementation research. Progress in these areas depends on equitable collaboration — based on partnership rather than extraction of data or authorship.

Why clinicians in high-income countries should care — and act

For clinicians in countries such as the Netherlands, global oncology may appear distant. This is misleading. The ethical argument is clear: disparities in cancer outcomes are not inevitable but they reflect unequal systems. There are also practical arguments. Engagement with global oncology sharpens clinical insight and fosters innovation that benefits patients in all settings from all backgrounds.

Engagement with global oncology sharpens clinical insight, for example, working in resource-limited settings strengthens diagnostic reasoning and prioritisation skills when advanced technologies are unavailable.  Moreover, genuine partnerships between institutions in high- and low-resource settings, combined with collaborative research, create a powerful engine for innovation. Co-developed solutions—such as adapted treatment protocols, task-shifting models, or cost-effective screening strategies—are often designed under constraints, making them efficient, scalable, and widely applicable. These innovations do not remain local: they inform more sustainable, value-based cancer care and improve patient outcomes across settings, regardless of geography or background.  And more importantly, cancer is inherently global. HPV transmission, social taboos, and migration patterns do not respect borders. As a result, inequities do not remain confined to LMICs. Within high-income countries, disparities persist. Together with the Dutch cancer registry (IKNL), we conducted a population-based study in the Netherlands and we demonstrated differences in incidence and survival of high-grade endometrial cancer among women of different countries of birth — even within an equal-access healthcare system.[8] The World Health Organisation global oncology statement “close the cancer care gap” is not only valid in other countries, but is already applicable locally.  

From local expertise to global impact

Engagement with global oncology does not require working abroad. It often begins locally — in communication with patients facing linguistic, cultural, or socioeconomic barriers — and extends to how expertise and research capacity are applied.

The Cervisur project in Suriname illustrates this. In a setting where screening coverage is limited, the Cervisur study team evaluates HPV self-sampling as a strategy to overcome barriers such as distance, stigma, and cost [10]. Importantly, the project is built on collaboration with local partners rather than exporting a high-income model.

Similarly, recent work led by PhD student George Chilinda in Malawi (under the UMC Utrecht global health fellowship umbrella in collaboration with Medicine Sans Frontiers) demonstrates the feasibility of ultrasound-based staging for cervical cancer in contexts where MRI is unavailable.[9] This approach offers a structured and affordable alternative for treatment planning. Rather than a compromise,  the research project represents innovation adapted to real-world constraints in low-resource settings. Such examples highlight a core principle: global oncology is not unidirectional knowledge transfer, but a reciprocal exchange that strengthens cancer care across settings.

The Mikroscope Kalimagezi project in Uganda is another example of a global oncology programme where access to diagnostic facilities is improved and diagnostic throughput enhanced by an efficient technological intervention. A rapid AI-based preliminary interpretation of pathology slides digitalised via a smartphone app helps to prioritise suspected cancer cases, while at the same time providing epidemiological insight, monitoring the oncological care process and building a training dataset.

What ‘closing the gap’ requires

Closing the global cancer care gap requires coordinated action across multiple domains.

Prevention must be prioritised, particularly HPV vaccination. Screening programmes need to be adapted — not simply transplanted — to local contexts. Community-based approaches, task-sharing, and low-cost diagnostics offer viable pathways forward.

Oncology should be recognised as a global health priority in its own right. Established frameworks outline actionable steps, including workforce development, infrastructure investment, and system strengthening.[3] These are achievable but require sustained commitment.

Research must also evolve. This includes equitable authorship, shared data ownership, locally driven priorities, and funding that supports institutions in LMICs. Building research capacity is itself a form of health system strengthening.

For clinicians in high-income settings, meaningful contributions often lie in partnership: collaborative research, mentorship, context-adapted guideline development, and advocacy within professional and policy arenas.

Cancer as a global health priority

Today, most people with cancer live in countries where access to oncological pathology, surgery, radiotherapy, chemotherapy, and early detection remains severely limited. Where a person is born remains one of the strongest predictors of cancer survival. This global  inequity projects itself into high-income settings healthcare settings. The global cancer care gap is local as well and is not inevitable. It reflects how health systems are organised and resourced, including decisions about funding, access, and prioritisation of vulnerable populations. Addressing it will require sustained engagement from clinicians, institutions, and policymakers. Engagement with global oncology not only sharpens clinical insight, but also fosters innovation that benefits patients in all settings and from all backgrounds. 

Global oncology working group 

In response to these challenges, we launched the Dutch Global Oncology Working Group to foster collaboration between clinicians, policymakers, and public health specialists, aiming to reduce cancer inequities through coordinated national and international efforts. 

This introductory paper marks the start of a series on the Global Health Perspectives platform addressing prevention, diagnostics, and treatment, as well as the role of the exposome — the cumulative impact of environmental, lifestyle, and socioeconomic factors throughout life — in shaping cancer risk and outcomes. By integrating insights from diverse populations and settings, global oncology can inform more effective and equitable strategies for care, while also guiding evidence-based policy to address disparities at both national and global levels.

REFERENCES 

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8. Kieviet JJE, Pijnenborg JMA, van der Aa M, et al. Country-of-birth disparities in high-grade endometrial cancer: a population-based analysis in the Netherlands. Eur J Cancer. 2026;239:116698.
9. Chilinda G, Moro F, Rijken MJ, et al. Ultrasound-based preoperative assessment for cervical cancer: a pragmatic staging strategy. Int J Gynecol Cancer. 2025.
10. Cervisur: HPV screening study in Suriname. Available from: https://cervisur.weebly.com/