Radiotherapy is a cornerstone of modern oncology, used for curative treatment, symptom relief, and improved quality of life across many cancer types. Yet worldwide access to radiotherapy remains highly unequal. In low- and middle-income countries (LMICs), limited infrastructure, workforce shortages, and financial and logistical barriers prevent many patients from receiving timely, effective treatment. This inequity is not a technical problem alone, it is a health systems challenge with direct consequences for survival.
The Scale of the Radiotherapy Access Gap
The global shortfall in radiotherapy capacity is especially severe in sub-Saharan Africa, where more than 20 countries have no access to radiotherapy services despite rising cancer incidence. Access differs sharply by income level: around 90% of patients in high-income countries can obtain radiotherapy when needed, while access falls to roughly 10% in low-income countries and about 50–60% in middle-income countries. These disparities translate into preventable deaths, particularly for cancers where radiotherapy plays a decisive role.
Cervical Cancer as a Marker of Inequity
Cervical cancer illustrates how unequal access to radiotherapy widens global survival gaps. Nearly 300,000 women die each year from cervical cancer in LMICs, even though the disease is often preventable and curable when detected early and treated effectively, conditions more commonly achieved in high-income settings.
The burden is heavily concentrated in sub-Saharan Africa, where 19 of the 20 countries with the highest cervical cancer burden globally are located. In this context, radiotherapy capacity becomes more than a service metric; it is a determinant of women’s health equity.
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Insights from the VCDNP Case Study
A case study developed by the Vienna Center for Disarmament and Non-Proliferation (VCDNP) examined why radiotherapy remains out of reach for so many patients in LMICs and offered recommendations grounded in lessons learned from Zambia’s approach to advancing access. A central message of the study is that “access” cannot be reduced to installing machines.
Utilization depends on the availability of treatment, affordability for patients and health systems, reliable maintenance, consistent supply chains, and long-term sustainability. The case study also drew from expert discussions held around World Cancer Day, emphasizing that progress requires coordinated policy action and investment across multiple levels of care.
International Support and the Role of the IAEA
International cooperation remains essential to addressing global radiotherapy inequities. The International Atomic Energy Agency (IAEA) has supported its Member States for decades in developing safe, secure, and effective cancer care programmes. Through its Technical Cooperation Programme and its Division of Human Health, alongside nuclear safety and security functions, the IAEA has helped more than 100 LMICs strengthen radiotherapy, diagnostic radiology, and nuclear medicine capacity.
This support extends from establishing services and building workforce capacity to providing guidance on nuclear safety and security, including cradle-to-grave management of cobalt-60 sources used in source-based radiotherapy. More recently, the IAEA has emphasized targeted interventions through its “Rays of Hope” initiative, which focuses on LMIC needs and prioritizes high-impact and sustainable solutions aligned with national commitments.
Expert Perspectives from World Cancer Day Discussions
Discussions convened by VCDNP highlighted that radiotherapy inequity is multidimensional. Dr. Alfredo Polo, a Radiation Oncologist at the IAEA Division of Human Health, stressed that the true proof of access lies in the use of radiotherapy, not simply the presence of a facility. From this standpoint, countries and partners must address affordability, service availability, and sustainability together, or new infrastructure risks becoming underutilized.
From Ghana, Dr. Joel Yarney, Head of the National Radiotherapy Oncology and Nuclear Medicine Centre at Korle Bu Teaching Hospital, described real-world barriers that patients face, including financial hardship, logistical challenges, and psychological obstacles to diagnosis and treatment.
He also outlined practical considerations related to technology selection and operation, discussing both linear accelerators (LINACs), which generate radiation using electricity, and cobalt-60 teletherapy units. In many LMIC contexts, the ability to repair and maintain equipment and to operate at full capacity is as important as the initial purchase. He further noted that long travel distances to limited radiotherapy centers reduce utilization, making geographic distribution of services a key determinant of access.
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Modern radiotherapy requires high accuracy in dose delivery and patient positioning, and without skilled teams, advanced equipment cannot deliver its intended benefits. She described how industry-supported education initiatives, including collaborations between Varian and universities in South Africa, aim to provide practical training for radiotherapy professionals across the continent.
Ms. Nina Wendling, CEO of the International Cancer Experts Corps, emphasized the magnitude of equipment disparities, particularly in access to LINACs. She noted that in Africa, 29 of 54 countries have LINAC facilities, with 12 countries relying on only a single LINAC, while more than 20 countries have none at all.
By comparison, the United States has roughly one LINAC per 150,000 people, whereas Africa has approximately 400 LINACs for over one billion people. She underscored that technology expansion must be matched by workforce development, partnership-building, mentoring networks, and twinning programmes that connect centers across regions to accelerate training and clinical capacity.
Choosing Technologies That Fit Local Needs
A recurring theme across expert discussions was that LMICs must make informed technology decisions that balance effectiveness with feasibility. LINACs offer important security advantages and enable modern techniques, but they require stable power, specialized maintenance, and highly trained personnel. Cobalt-60 teletherapy units may offer robustness in certain settings but raise additional requirements for source management and long-term safety oversight. Ultimately, the most appropriate approach is not universal; it depends on national needs, workforce readiness, maintenance ecosystems, affordability, and long-term sustainability planning.
Radiotherapy as a Core Component of Comprehensive Cancer Care
Improving radiotherapy access should be understood as part of building comprehensive cancer care systems rather than as a single investment in machines. As the global cancer burden grows, the international community alongside governments, technical agencies, academic institutions, and industry must strengthen cancer care pathways, expand equitable access to radiotherapy, and ensure services are safe, affordable, and consistently available. Closing the radiotherapy gap is both a clinical necessity and a moral imperative, because where a person lives should not determine whether they can receive a proven, life-saving cancer treatment.
Written by Nare Hovhannisyan, MD