Navigating the Gap: A Review of Time to Treatment Intervals and Cervical Cancer Survival in Sub-Saharan Africa

Abstract

Background: While cervical cancer is highly preventable through the HPV vaccine, early detection, and treatment, it continues to be a significant contributor to the morbidity and mortality of women in Sub-Saharan Africa (SSA).  Poorer survival outcomes in SSA compared to high-income countries can, to a large extent, be attributed to patients being unable or unwilling to present to the health system to obtain curative treatment in a timely manner. Time-to-treatment interval (TTI) has gained traction as a key measure of health system performance and is also likely to impact cervical cancer outcomes. Methods: This narrative review provided a synthesis of available evidence on the role TTIs play regarding cervical cancer and survival in SSA. Various electronic databases and relevant institutional repositories were searched to conduct the review, namely; PubMed/MEDLINE, Scopus, Embase, Web of Science, African Journals Online (AJOL), Google Scholar, GLOBOCAN, IARC and WHO repositories provided cancer statistics and institutional reports, while reference lists and grey literature were also reviewed.  Only studies published between 2010 and 2025 and that contain cervical cancer-related studies on the component of health system delays/survivor challenges in SSA and the associated survivorship were reviewed and subjected to thematic analysis. Results: Evidence shows that in Sub-Saharan Africa, it is common for prolonged TTIs to occur during various stages of the continuum of care, including identification of symptoms, diagnosis, referral, treatment planning, and formal initiation of treatment. Main delays are caused by a combination of inadequate cancer care infrastructure, shortage of radiotherapy services, limited pathology, a large gap in the workforce, a weak referral system, financial barriers, and disparities in physical access to care. Most women present with late-stage disease, which limits the potential for curative treatment. Delays in treatment are also related to advanced disease, which is associated with decreased treatment effectiveness, increased recurrence, and poorer survival. Promising interventions to address the barriers to access, such as decentralizing oncological services, patient navigation programs, and the use of telemedicine and an increase in radiotherapy services, have potential to address these barriers. Conclusion: Long TTIs remain a key obstacle to cervical cancer survival in SSA. Improving community-based protective structures, including treatment, referral, and diagnostic systems, skilled workforce engagement, and financial systems, will enhance timely treatment and decrease cervical cancer mortality in SSA.