Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries

Prevalence, Screening, Treatment, Palliative Care, and Human Resources Training


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Obstetrics and Gynecology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ferlay J.
        • Colombet M.
        • Soerjomataram I.
        • et al.
        Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods.
        Int J Cancer. 2019; 144: 1941-1953
        • Sung H.
        • Ferlay J.
        • Siegel R.L.
        • et al.
        Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2021; 71: 209-249
        • Parkin D.M.
        • Bray F.
        • Ferlay J.
        • et al.
        Estimating the world cancer burden: Globocan 2000.
        Int J Cancer. 2001; 94: 153-156
        • Ferlay J.
        • Shin H.R.
        • Bray F.
        • et al.
        Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.
        Int J Cancer. 2010; 127: 2893-2917
        • International Agency for Research on Cancer
        Breast cancer screening. IARC handbooks of cancer prevention.
        IARC, Lyon2002
        • Nogueira M.C.
        • Fayer V.A.
        • Corrêa C.S.L.
        • et al.
        Inequities in access to mammographic screening in Brazil.
        Cadernos de saude publica. 2019; 35: e00099817
        • Nuche-Berenguer B.
        • Sakellariou D.
        Socioeconomic determinants of cancer screening utilisation in Latin America: a systematic review.
        PLoS One. 2019; 14: e0225667
        • Gutnik L.A.
        • Matanje-Mwagomba B.
        • Msosa V.
        • et al.
        Breast cancer screening in low-and middle-income countries: a perspective from Malawi.
        J Glob Oncol. 2016; 2: 4-8
        • Corbex M.
        • Burton R.
        • Sancho-Garnier H.
        Breast cancer early detection methods for low and middle-income countries, a review of the evidence.
        Breast. 2012; 21: 428-434
        • da Costa Vieira R.A.
        • Biller G.
        • Uemura G.
        • et al.
        Breast cancer screening in developing countries.
        Clinics (Sao Paulo). 2017; 72: 244-253
        • Black E.
        • Richmond R.
        Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward.
        Globalization and Health. 2019; 15
        • Sankaranarayanan R.
        • Ramadas K.
        • Thara S.
        • et al.
        Clinical breast examination: preliminary results from a cluster randomized controlled trial in India.
        J Natl Cancer Inst. 2011; 103: 1476-1480
        • Shetty M.K.
        • Longatto-Filho A.
        Early detection of breast, cervical, ovarian and endometrial cancers in low resource countries: an integrated approach.
        Indian J Surg Oncol. 2011; 2: 165-171
        • Shalu R.
        • Ritu Y.
        • Meenakshi B.C.
        • et al.
        Challenges in Screening and Early Diagnosis of Female Cancers.
        J Gynecol Oncol. 2021; 41067
        • Hampl M.
        • Sarajuuri H.
        • Wentzensen N.
        • et al.
        Effect of human papillomavirus vaccines on vulvar, vaginal, and anal intraepithelial lesions and vulvar cancer.
        Obstet Gynecol. 2006; 108: 1361-1368
        • Grossman D.C.
        • Curry S.J.
        • Owens D.K.
        • et al.
        Screening for ovarian cancer: US preventive services task force recommendation statement.
        JAMA. 2018; 319: 588-594
        • Rosenblatt K.A.
        • Thomas D.B.
        Reduced risk of ovarian cancer in women with a tubal ligation or hysterectomy. The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives.
        Cancer Epidemiol Prev Biomarkers. 1996; 5: 933-935
        • Pegoraro R.J.
        • Moodley M.
        • Rom L.
        • et al.
        P53 codon 72 polymorphism and BRCA 1 and 2 mutations in ovarian epithelial malignancies in black South Africans.
        Int J Gynecol Cancer. 2003; 13: 444-449
        • Manchana T.
        • Phoolcharoen N.
        • Tantbirojn P.
        BRCA mutation in high grade epithelial ovarian cancers.
        Gynecol Oncol Rep. 2019; 29: 102-105
        • Meara J.G.
        • Leather A.J.
        • Hagander L.
        • et al.
        Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.
        Lancet. 2015; 386: 569-624
        • Sullivan R.
        • Alatise O.I.
        • Anderson B.O.
        • et al.
        Global cancer surgery: delivering safe, affordable, and timely cancer surgery.
        Lancet Oncol. 2015; 16: 1193-1224
        • Agarwal R.
        • Rajanbabu A.
        • Nitu P.V.
        • et al.
        A prospective study evaluating the impact of implementing the ERAS protocol on patients undergoing surgery for advanced ovarian cancer.
        Int J Gynecol Cancer. 2019; 29: 605-612
        • Bhandoria G.P.
        • Bhandarkar P.
        • Ahuja V.
        • et al.
        Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice.
        Int J Gynecol Cancer. 2020; 30: 1471-1478
        • Deo S.
        • Ray M.
        • Bansal B.
        • et al.
        Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low-and middle-income countries: a single-center experience of 232 cases.
        World J Surg Oncol. 2021; 19: 164
        • Mulisya O.
        • Sikakulya F.K.
        • Mastaki M.
        • et al.
        The challenges of managing ovarian cancer in the developing world.
        Case Rep Oncological Med. 2020; 20208379628
        • World Health Organization
        Global action plan for the prevention and control of noncommunicable diseases 2013-2020.
        World Health Organization, Geneva, Switzerland2013
        • World Health Organization
        Model List of Essential Medicines - 22nd List, 2021. 3. World Health Organization, Geneva2021: IGO
        • von Grünigen S.
        • Geissbühler A.
        • Bonnabry P.
        The safe handling of chemotherapy drugs in low-and middle-income countries: An overview of practices.
        J Oncol Pharm Pract. 2022; 28: 410-420
        • Zubizarreta E.H.
        • Fidarova E.
        • Healy B.
        • et al.
        Need for radiotherapy in low and middle income countries – the silent crisis continues.
        Clin Oncol (R Coll Radiol). 2015; 27: 107-114
        • Grover S.
        • Xu M.J.
        • Yeager A.
        • et al.
        A systematic review of radiotherapy capacity in low-and middle-income countries.
        Front Oncol. 2015; 4
        • DIrectory of RAdiotherapy Centres (DIRAC)
        International Atomic Energy Agency. DIRAC v2.0.7 (40659).
        (Available at:) (Accessed March 1, 2022)
        • Abdel-Wahab M.
        • Gondhowiardjo S.S.
        • Rosa A.A.
        • et al.
        Global Radiotherapy: Current Status and Future Directions—White Paper.
        JCO Glob Oncol. 2021; 7: 827-842
        • Hui D.
        • Bruera E.
        Integrating palliative care into the trajectory of cancer care.
        Nat Rev Clin Oncol. 2016; 13: 159-171
        • Cain J.M.
        • Denny L.
        Palliative care in women’s cancer care: global challenges and advances.
        Int J Gynecol Obstet. 2018; 143: 153-158
        • Yamaguchi T.
        • Kuriya M.
        • Morita T.
        • et al.
        Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN).
        BMJ Support Palliat Care. 2017; 7: 23-31
        • Tapsfield J.B.
        • Jane Bates M.
        Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi.
        BMC Palliative Care. 2011; 10
        • Pastrana T.
        • Eisenchlas J.
        • Centeno C.
        • et al.
        Status of palliative care in Latin America: looking through the Latin America Atlas of Palliative Care.
        Curr Opin Support Palliat Care. 2013; 7: 411-416
        • Harding R.
        • Selman L.
        • Agupio G.
        • et al.
        The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries.
        Eur J Cancer. 2011; 47: 51-56
        • Munday D.
        • Kanth V.
        • Khristi S.
        • et al.
        Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies.
        BMJ Support Palliat Care. 2019; 9
        • Spence D.
        • Merriman A.
        • Binagwaho A.
        Palliative care in Africa and the Caribbean.
        PLoS Med. 2004; 1
        • Vallath N.
        • Rahul R.R.
        • Mahanta T.
        • et al.
        Oncology-based palliative care development: the approach, challenges, and solutions from north-east region of india, a model for low-and middle-income countries.
        JCO Glob Oncol. 2021; 7: 223-232
        • Ngoma M.
        • Mushi B.
        • Morse R.S.
        • et al.
        mPalliative care link: examination of a mobile solution to palliative care coordination among tanzanian patients with cancer.
        JCO Glob Oncol. 2021; 7: 1306-1315
        • Agboola S.O.
        • Ju W.
        • Elfiky A.
        • et al.
        The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials.
        J Med Internet Res. 2015; 17
        • Mathieu K.M.
        • YouYou T.G.
        • Hicks M.L.
        • et al.
        Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development.
        Ecancermedicalscience. 2021; 15
        • Rosen B.
        • Itsura P.
        • Tonui P.
        • et al.
        Development of a comprehensive and sustainable gynecologic oncology training program in western Kenya, a low resource setting.
        Gynecol Oncol Rep. 2017; 21: 122-127
        • Erem A.S.
        • Appiah-Kubi A.
        • Konney T.O.
        • et al.
        Gynecologic oncology sub-specialty training in Ghana: a model for sustainable impact on gynecologic cancer care in sub-Saharan Africa.
        Front Public Health. 2020; 8603391
        • Randall T.C.
        • Somashekhar S.P.
        • Chuang L.
        • et al.
        Reaching the women with the greatest needs: Two models for initiation and scale-up of gynecologic oncology fellowship trainings in low-resource settings.
        Int J Gynecol Obstet. 2021; 155: 115-122
      1. Gynecologic oncology global curriculum and mentorship program 2021 progress report. International Gynecological Cancer Society, 2022 (Available at:) (Accessed March 4, 2022)
        • Eav S.
        • Schraub S.
        • Dufour P.
        • et al.
        Oncology in Cambodia.
        Oncology. 2012; 82: 269-274
        • Karim S.
        • Sunderji Z.
        • Jalink M.
        • et al.
        Oncology training and education initiatives in low and middle-income countries: a scoping review.
        Ecancermedicalscience. 2021; 15