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.