Global Cancer Gap: Radiotherapy Capacity for 8% of Need in Low-Income Countries

Whether a person with cancer can be diagnosed, treated and kept free of pain depends heavily on the services their country has built. In 2022, existing radiotherapy machines in low-income countries could treat an estimated 8 in every 100 people who needed radiotherapy, against more than enough capacity in high-income countries taken as a group. The same gaps run through pathology, the cancer workforce and palliative care, and survival from breast cancer, for one, is lowest in the poorest countries.^[1][2]

Behind these figures are people who find a lump and wait months for a biopsy to be read, families who travel to another country for radiotherapy or cannot, and people near the end of life who have no access to oral morphine. None of this reflects how people respond to cancer. It reflects where machines, laboratories, trained staff and medicines are, and where they are not. This piece brings together the evidence on those gaps, focusing on the parts sibling articles cover least: radiotherapy, pathology, the workforce and palliative care. For the overall numbers of cases and deaths by country income, see our overview of cancer worldwide; this article is part of our cancer research library.

Radiotherapy capacity ranges from about 8% of estimated need in low-income countries to more than 100% in high-income countries

Radiotherapy is used both to treat cancer and to relieve its symptoms. A 2026 global assessment estimated that of 18.7 million people newly diagnosed with cancer in 2022, around 11.2 million would have needed radiotherapy at some point.^[1] The authors compared that need with the megavoltage machines recorded in the International Atomic Energy Agency's Directory of Radiotherapy Centres (DIRAC), assuming each machine can treat 450 people a year.

Worldwide, 16,941 megavoltage machines were recorded, giving an estimated global coverage of 68% and a shortfall of 7,944 machines in 2022. By World Bank income group the gap widens steeply:^[1]

• High-income countries: 103.2% coverage overall, a small surplus of 319 machines against estimated need.
• Upper-middle-income countries: 50.0% coverage, a shortfall of 5,194 machines.
• Lower-middle-income countries: 34% coverage, a shortfall of 2,946 machines.
• Low-income countries: 7.9% coverage. Ten countries were below 10%, and no low-income country reached more than 13%.

Thirty-five of the 215 countries and territories listed by the World Bank reported no data or no radiotherapy facility, among them Afghanistan, Chad, Haiti, Liberia, Sierra Leone, Somalia and South Sudan.^[1] The machines that do exist are often old: only 5.8% of operating equipment worldwide was under five years old. The study projects that 16.7 million people a year will need radiotherapy by 2045, so the gap will widen unless capacity grows.^[1] This is consistent with GLOBOCAN 2024, which projects new cancer cases rising 67% to 34.4 million by 2050, "with the largest proportional increases in lower Human Development Index countries" (HDI tiers, a different grouping from World Bank income).^[4]

Paying for treatment matters too. In a WHO survey of 115 countries published in 2024, radiation services were on average four times more likely to be in the publicly financed health benefit package in high-income countries than in lower-income ones. Only 39% of participating countries covered the basics of cancer management in their core health services.^[5]

Closing the gap would not only cost money. The Lancet Oncology Commission on radiotherapy (2015) modelled scale-up in low- and middle-income countries between 2015 and 2035 at US$96.8 billion to US$184.0 billion depending on how efficiently services were run. It estimated 26.9 million life-years saved and a net economic benefit of US$278.1 billion to US$365.4 billion over the same period.^[6] These are model estimates resting on assumptions about costs, staffing and productivity made in 2015, not measured results.

Without pathology there is no diagnosis, and nearly half the world has little or no access to diagnostics

Almost every cancer diagnosis depends on a pathologist examining tissue, and the type and stage it confirms decide which treatment fits. When pathology is missing or slow, people are treated without a firm diagnosis, treated late, or not treated at all. Breast, cervical and childhood cancers are among those where the choice of treatment rests on what the laboratory reports.

The Lancet Commission on diagnostics (2021), which looked at laboratory medicine, pathology and imaging across all conditions, not only cancer, concluded that "just under half (47%) of the world's population have little to no access to diagnostics". It estimated that only about 19% of people in low-income and lower-middle-income countries had access, at primary care level, to even the simplest diagnostic tests, other than those for HIV and malaria.^[7]

On staffing, the Commission put the scale of the gap in years: "In sub-Saharan Africa, just to address the shortfall in pathologists at the present rate of training, it will take more than 400 years to reach around the same ratio of pathologists per 100 000 population that currently exists in the USA and in the UK." It reported similar shortfalls for radiologists and other diagnostic staff.^[7] An earlier Lancet series on pathology and laboratory medicine in low- and middle-income countries identified four major barriers to delivering these services, treating the gap as a problem of whole health systems rather than of any single missing machine or person.^[8]

Survival data follow the same income gradient. The WHO Global Breast Cancer Initiative reports five-year net survival from breast cancer for 2017 to 2021 of 87.3% in high-income countries, 60.1% in lower-middle-income countries and 41.9% in low-income countries.^[2] Our breast cancer evidence article sets out the incidence and mortality side of that comparison.

In 27 countries, one clinical oncologist served more than 1,000 people newly diagnosed each year, on figures from around 2012

Machines and laboratories need people to run them. A global survey of the clinical oncology workforce, published in 2018, gathered counts of oncologists for 93 countries from 30 published sources (for all but three countries, counts from 2011 to 2015) and set them against new cancer cases estimated by GLOBOCAN 2012.^[9] It found:

• eight countries with no clinical oncologist at all;
• 27 countries (29%) where each clinical oncologist would be responsible for more than 1,000 people newly diagnosed with cancer each year, 25 of them in Africa;
• 22 countries (24%) where each clinical oncologist would care for fewer than 150 newly diagnosed people.

The same study estimated the ratio of cancer deaths to new cases (the mortality-to-incidence ratio, a rough indicator of how often a diagnosis ends in death) and found it above 70% in 26 countries, 21 of them in Africa.^[9] These data are now around a decade old, and definitions of "clinical oncologist" vary between countries, so they show the shape of the gap rather than today's exact numbers. No more recent global count by income group was available to us at source.

The workforce gap reaches beyond oncologists to surgeons, radiation therapists, medical physicists, pathologists, specialist nurses and pharmacists. As noted above, the diagnostics Commission found shortfalls on a similar scale for radiologists and laboratory staff.^[7]

Medicines are the other half of treatment. In the WHO 2024 survey, services for lung cancer were 4 to 7 times more likely to be in the publicly financed benefit package in high-income countries than in lower-income countries, and stem-cell transplantation 12 times more likely.^[5] When a service is not publicly financed, the cost falls on the family. Our article on access to cancer medicines covers availability and affordability of essential cancer medicines in detail.

Most people who need palliative care live in low- and middle-income countries, and few receive it

Where curative treatment is out of reach, or once it no longer helps, palliative care relieves pain and other symptoms and supports families. It is needed for many conditions, not only cancer. WHO estimates that 56.8 million people a year need palliative care, including 25.7 million in the last year of life, most of them in low- and middle-income countries. Worldwide, only about 14% of people who need it receive it.^[3]

Pain relief shows the gap most plainly. WHO reports that in 2018, 79% of the world's population, mainly people in low- and middle-income countries, consumed only 13% of the morphine used for pain relief.^[3] These figures describe access to medicine, not how much pain people have. Among children who need palliative care, 98% live in low- and middle-income countries.^[3]

Financing follows the same pattern. In the WHO survey of 115 countries, only 28% covered care for people needing palliative care, including general pain relief, in their core health services.^[5] Some countries have shown that this can change. Uganda introduced palliative care more than 25 years ago,^[10] and a 2026 review of cancer and palliative nursing there found that "nurse-led innovations and task shifting have improved access in resource-limited and rural settings".^[11] End-of-life care is the subject of a separate article in this library.

What is working: shorter journeys to treatment, national plans and shared targets

The evidence on what closes these gaps is thinner than the evidence that they exist, and much of it comes from programme evaluations rather than trials. Some of it is encouraging.

Helping people through the system. In Rwanda, a pilot of digitally enabled patient navigation linked five referral hospitals and, in 2022, assigned navigators to people with breast or cervical cancer. The evaluation compared them with cancer registry records of people diagnosed between 2016 and 2021, before navigation was available. Mean time from diagnosis to starting treatment was 28 days in the navigated group against 82 days among the earlier controls, and 84% started treatment within 60 days compared with 58% (75 navigated people and 1,020 controls in this analysis).^[12] Pathology turnaround was similar in both groups (about 16 days), which suggests that navigation shortened the path from result to treatment but could not by itself speed up a stretched laboratory. The evaluation was a retrospective comparison with historical controls, not a randomised trial, so some of the difference may reflect changes in services between the two periods or who was enrolled; it also recorded heavy navigator workloads.^[12]

Shared global targets that governments sign up to. The WHO Global Initiative for Childhood Cancer aims for at least 60% survival for children with cancer worldwide by 2030. WHO reports that it has engaged with 87 countries across all six WHO regions, and that 50 governments have built childhood cancer into their national health strategies.^[13] The WHO Global Breast Cancer Initiative aims at "reducing breast cancer by 2.5% per year, which over a 20-year period would save 2.5 million lives", through three pillars: health promotion and early detection, timely diagnosis, and comprehensive treatment.^[2] These are targets, not results; whether they are met will depend on funding for the services described above. Our children's cancer article covers survival for children by country income, and the medicines article linked above describes one programme supplying childhood cancer medicines to lower-income countries.

Preventing the cancers that need the most treatment. WHO estimates that infections such as HPV and hepatitis account for roughly 30% of cancer cases in low- and lower-middle-income countries.^[14] Preventing infection-linked cancers is one of the few ways to ease future demand on treatment services where they are scarcest.

What the evidence asks of us

The figures point to gaps in services, and to the people and money needed to fill them. They suggest:

• Count radiotherapy, pathology and palliative care as core cancer services, and finance them publicly. In WHO's 2024 survey, only 39% of countries covered the basics of cancer management and 28% covered palliative care in their core health services.^[5] Treatment that families must pay for in full is not, in practice, available to most of them.
• Plan for the machines and the staff together. Radiotherapy capacity in low-income countries met an estimated 7.9% of need in 2022, and need is projected to grow.^[1] The radiotherapy Commission's modelling suggests the investment returns more than it costs over two decades, on its stated assumptions.^[6] Funders and governments can treat this as long-term infrastructure, with training for physicists, radiation therapists and oncologists built in.
• Make diagnosis possible. With 47% of the world's population having little or no access to diagnostics, and pathologist training in sub-Saharan Africa far behind need, national cancer plans can include laboratories and the people to staff them.^[7]
• Remove the barriers to pain relief. WHO's figures show how unevenly morphine for pain relief is distributed between countries.^[3] Nurse-led models, as in Uganda, show one way to reach more people.^[11]
• Fund what shortens the path to treatment, and evaluate it. Programmes like Rwanda's navigation pilot can be tested in larger, better-controlled studies so that governments can invest with confidence.^[12]
• Hold the global initiatives to their targets. The childhood and breast cancer initiatives give governments, charities and funders measurable goals to report against.^[13][2]

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.

Why we're publishing this

Charities, support groups and hospices working with people affected by cancer in low- and middle-income countries already know these gaps first-hand. National and international decisions about funding are made on figures, and the figures are scattered across radiotherapy directories, diagnostic commissions, workforce surveys and WHO reports. We have brought them together in one place, with sources, so that the people and organisations making the case for services can cite them. The case is theirs; our part is to set out the evidence clearly.

How to read this data

Two different groupings appear in this article. World Bank income groups (low, lower-middle, upper-middle, high) classify countries by national income per person; the radiotherapy study states that it uses these. WHO's breast cancer survival and benefit-package figures are labelled by income group (low, lower-middle and high income; "high-income" and "lower-income") without naming a classification on the pages cited. The Human Development Index (HDI) tiers used by GLOBOCAN also take account of health and education. The two overlap but are not the same, so figures from one should not be compared directly with figures from the other.

Radiotherapy coverage is a modelled estimate: machine counts from DIRAC (country entries updated between 2018 and 2025) divided by estimated need, based on GLOBOCAN 2022 cases and an assumed 450 people treated per machine each year. Coverage above 100% for a group does not mean that everyone in every country is reached. The oncologist counts are mostly from 2011 to 2015, set against 2012 incidence estimates, and use varying definitions. The cost and benefit figures from the radiotherapy Commission are 2015 projections. Five-year net survival figures cover 2017 to 2021, not today. The Rwanda navigation results come from a single pilot compared with earlier registry controls, without randomisation. Evidence is thinnest for the countries with the fewest services, because those countries often also lack cancer registries.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

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2. World Health Organization. The Global Breast Cancer Initiative. WHO, accessed November 2026. who.int/initiatives/global-breast-cancer-initiative
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