A study by the London School of Hygiene and Tropical Medicine found that in low- and middle-income countries (LMICs), only one in five cancers in women is diagnosed at an early stage.
Early diagnosis rates for female cancers, including breast and cervical cancer, are higher in high-income countries (HICs), reaching one in three women.
For ovarian cancer, the proportion of women worldwide diagnosed with early-stage disease is generally less than 20% (1 in 5), but the situation for women in LMICs is still slightly worse.
The study looked at the three most common cancer types in women and found variations in stage at diagnosis, type of treatment, and how well treatments were aligned with international guidelines.
This study, part of the VENUSCANCER project, part of the CONCORD program for global monitoring of cancer survival, provides the first global picture of pathways to treatment and provides important evidence to support efforts aimed at improving cancer control around the world.
Women in LMIC are diagnosed too late
Despite decreasing inequalities in surgery for women with cancer, researchers found that too many women, especially those in LMIC, are not diagnosed until their cancer is well advanced.
The proportion of women whose cancer was detected early was more than 40% in HIC for cervical or breast cancer, but much lower in LMICs and less than 20% for all three cancers except in Cuba (30% for breast cancer) and Russia (36% for cervical cancer and 27% for ovarian cancer).
These differences mean that women in most LMICs have a lower chance of survival than in HICs.
Metastatic breast cancer (cancer that has spread from its original site to another part of the body) accounted for less than 10% in most HICs but was more frequent in LMICs (range 2-44%). The rate of advanced cervical cancer was less than 15% in most countries of the world.
Ovarian cancer is most commonly diagnosed in late stages
Ovarian cancer was still mostly diagnosed at an advanced stage. Ovarian cancer is often referred to as a “silent killer” because it causes vague symptoms (abdominal pain and swelling) and can go undetected for long periods of time, leading to a terminal diagnosis.
Treatment for early-stage female cancers was more consistent
Data from more than 275,000 women in 39 countries revealed that surgery is commonly offered to women with early-stage cancer in most countries, although not always in line with international guidelines.
Regarding treatment of the three cancers, surgery was offered to 78% of women in HIC and 56% of women in LMIC, but initial treatment for early-stage tumors was more often consistent with clinical guidelines for cervical and ovarian cancer than for breast cancer.
In most European countries, women with early-stage breast cancer were treated with breast-conserving surgery and radiotherapy (67-78%) according to clinical guidelines. This proportion was lower in Canada (60%) and the United States (53%).
In contrast, in LMICs, 30–70% of women with early-stage breast cancer underwent mastectomy. However, mastectomies were also common in the United States, Canada, Estonia, the Netherlands, and Portugal.
Informing global policies on cancer treatment and control
Professor Claudia Alemani, Professor of International Public Health at the London School of Hygiene and Tropical Medicine, said: “This study was a major undertaking to create the largest and most detailed global population-based database to date containing data on stages, staging procedures, treatments and biomarkers for the three most common cancers in women.”
“VENUSCANCER provides the first real-world picture of patterns of care and treatment consistency in line with clinical guidelines on a global scale.”
She added: “Evidence from this study should help inform global policies on cancer control, including the WHO’s Global Breast Cancer Initiative and Cervical Cancer Elimination Initiative.”
Compliance with international guidelines needs to be improved
Overall, this study revealed that countries vary in the extent to which they follow international clinical guidelines.
“This suggests that more needs to be done to tailor internationally agreed recommendations to local needs and resources, simplify them and make them available in local languages,” said Dr. Veronica Di Carlo, a researcher in LSHTM’s Cancer Survival Group.
“Women around the world should discuss their treatment options with their health care professionals and make decisions knowing they have the best options available to them by following recommended guidelines.”
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