3060 - Current and Projected Gaps in the Global Availability of Brachytherapy for Cervical Cancer
Presenter(s)
G. Harris1,2, D. Abu Awwad2, S. R. Thompson3, V. Batumalai4, M. Mel5, S. Chopra6, S. Grover7, D. Rodin8, and M. L. Yap9; 1Chris O'Brien Lifehouse, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3Prince of Wales Hospital, Randwick 2031, Australia, 4GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia, 5Calmette Hospital, Phnom Penh, Cambodia, 6ACTREC,Tata Memorial Centre,Homi Bhabha National Institute, Navi Mumbai, India, 7Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 8Division of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada, 9Liverpool Hospital, Sydney, Australia
Purpose/Objective(s):
Cervical cancer is the fourth most common cancer in women globally, with a higher incidence and mortality observed in low and middle-income countries (LMICs). Brachytherapy (BT) is a critical component of the Third Pillar of the WHO Cervical Cancer Elimination initiative, however major global gaps in access to BT machines exist. We aimed to estimate availability of BT machines globally for the treatment of cervical cancer using a national income-group adjusted model.Materials/Methods:
Cervical cancer incidence data for 2022 and projected for 2045 was extracted from IARC’s GLOBOCAN database. The CCORE brachytherapy utilization rate (BTU) model previously developed was based on high income country (HIC) cervical cancer staging data, and this was adjusted for LMICs according to cervical cancer staging data for each region (using national cancer registry reports where possible or published prospective cohort data) to estimate the current and projected optimal BTU (i.e. proportion of cervical cancer cases requiring BT based on guideline recommendations), and to estimate the number of BT machines needed in each country to meet this demand. The model was adjusted to account for the casemix of BT machines in different income settings. Data on the number of BT machines available nationally was retrieved from the IAEA DIRAC database and a literature search. Gaps were determined by comparing the projected number of BT machines needed with the adjusted number of BT machines available in each country. Gaps in BT machine availability were also compared against age standardized cervical cancer mortality.
Results:
Globally, there were 662,044 new cervical cancer cases in 2022, and 425,847 of these (64%) would benefit from BT. To meet the global demand, 2234 BT machines are needed however the current global supply of BT machines for the treatment of cervical cancer is 955 (43%). Currently there is a deficit of 1372 BT machines in LMICs for the treatment of cervical cancer, highest in Asia Pacific (904 BT machines), followed by Africa (443 BT machines). 1986 additional BT machines are needed to meet the projected demand for cervical cancer treatment in LMICs by 2045, even adjusting for the universal roll-out of bivalent HPV vaccination in LMICs and assuming a stage distribution reflecting a population with ongoing screening. The deficit of BT machine availability in LMICs correlates with age standardized cervical cancer mortality globally.Conclusion:
There is a gross deficit in the availability of BT for the optimal treatment of cervical cancer in LMICs. Even accounting for the widespread rollout of primary and secondary prevention programs for cervical cancer in LMICs, this gap in BT machine availability is projected to continue. This study can be used to provide evidence for the need to incorporate BT into national cancer control plans in LMICs, and to inform policy makers and governments of the urgent need for investment in BT for cervical cancer in LMICs.