Radiation therapy is a cornerstone of modern oncology and is used to curatively treat many types of cancer, reduce symptoms, and improve quality of life. However, global 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 and effective treatment. This inequality is not just a technical problem, but a health system challenge that directly impacts survival.
Size of radiotherapy access gap
The global radiotherapy capacity shortage is particularly acute in sub-Saharan Africa, where more than 20 countries lack access to radiotherapy services despite increasing cancer incidence. Access varies widely by income level. Approximately 90% of patients in high-income countries have access to radiotherapy when needed, whereas access drops to about 10% in low-income countries and about 50-60% in middle-income countries. These differences lead to preventable deaths, especially in cancers where radiotherapy plays a crucial role.
Cervical cancer as an indicator of inequality
Cervical cancer shows how unequal access to radiotherapy widens global survival disparities. Nearly 300,000 women die from cervical cancer each year in LMICs, and the condition is more common in high-income settings, even though the disease is often preventable and treatable with early detection and effective treatment.
The burden of cervical cancer is highly concentrated in sub-Saharan Africa, with 19 of the 20 countries with the highest burden of cervical cancer in the world located in Africa. In this context, radiotherapy capacity becomes more than just a service indicator. It is a determinant of women’s health equity.
AI in Radiation Therapy Planning and Workflow Optimization 2026
Insights from the VCDNP case study
A case study produced by the Vienna Center for Disarmament and Non-Proliferation (VCDNP) examines why radiotherapy remains unaffordable for so many patients in LMICs and offers recommendations based on lessons learned from Zambia’s approach to promoting access. The central message of this study is that “access” cannot be limited to just installing machines.
Utilization depends on treatment availability, affordability to patients and health systems, reliable maintenance, consistent supply chains, and long-term sustainability. The case study also built on expert discussions held around World Cancer Day, which highlighted that progress requires coordinated policy actions and investments across multiple levels of care.
International support and the role of the IAEA
International cooperation remains essential to address global radiotherapy inequalities. International Atomic Energy Agency (IAEA) has been helping member countries develop safe, secure and effective cancer treatment programs for decades. Alongside its nuclear safety and security functions, the IAEA has helped more than 100 LMICs strengthen their radiotherapy, radiodiagnostic, and nuclear medicine capabilities through its technical cooperation programs and human health sector.
This support ranges from service establishment and workforce capacity building to providing guidance on nuclear safety and security, including the cradle-to-grave management of cobalt-60 sources used in source-based radiotherapy. More recently, the IAEA has emphasized targeted interventions through its Beacon of Hope initiative, which focuses on the needs of LMICs and prioritizes high-impact sustainable solutions that align with national commitments.
Expert perspectives from World Cancer Day discussions
Discussions convened by VCDNP highlighted the multidimensionality of radiotherapy inequalities. Dr. Alfred Polo, radiation oncologist at the IAEA Human Health Division, emphasized that the real evidence of access lies in the use of radiotherapy, not just the presence of facilities. In this light, countries and partners must jointly address affordability, service availability and sustainability. Otherwise, you risk underutilizing your new infrastructure.
From Ghana, Dr. Joel Yarney, Director of the National Center for Radiotherapy Oncology and Nuclear Medicine at Korle Bu Teaching Hospital, described the real barriers faced by patients, including financial difficulties, logistical challenges, and psychological barriers to diagnosis and treatment.
He also discussed both linear accelerators that use electricity to produce radiation (LINAC) and cobalt-60 teletherapy devices, and outlined practical considerations for technology selection and operation. In many LMIC settings, being able to repair and maintain equipment and keep it running at full capacity is as important as the initial purchase. He further pointed out that long travel distances to limited radiotherapy centers reduce utilization, and that the geographic distribution of services is an important determinant of access.
Breaking down the myth of radiotherapy toxicity
Modern radiation therapy requires high precision in dose delivery and patient positioning, and without a skilled team, advanced equipment cannot provide its intended benefits. She explained that industry-supported education initiatives, such as Varian’s collaboration with South African universities, aim to provide practical training to radiotherapy professionals across Africa.
Nina Wendling, CEO of the International Association of Cancer Experts, highlighted the huge disparity in facilities, particularly in access to LINAC. He pointed out that in Africa, 29 out of 54 countries have LINAC facilities, 12 of which rely on only one LINAC, and more than 20 countries have no LINAC at all.
By comparison, the United States has about one LINAC for every 150,000 people, while Africa has about 400 LINACs for more than 1 billion people. He emphasized that technology expansion must be matched with workforce development, partnership building, mentoring networks, and partnering programs that connect centers across regions to accelerate training and clinical capacity.
Selecting technology that meets local needs
A recurring theme in expert discussions was that LMICs must make informed technology decisions that balance effectiveness and feasibility. LINAC offers important security benefits and enables the latest technology, but requires reliable power, professional maintenance, and highly trained personnel. Cobalt-60 teletherapy devices may offer robustness in certain settings, but pose additional requirements for source control and long-term safety monitoring. After all, the most appropriate approach is not universal. It depends on national needs, workforce readiness, maintenance ecosystem, affordability, and long-term sustainability plans.
Radiotherapy is the core of comprehensive cancer treatment
Improving access to radiotherapy should be understood as part of building a comprehensive cancer treatment system, rather than as a standalone investment in machinery. As the global burden of cancer increases, the global community, together with governments, technical institutions, academia, and industry, must strengthen cancer treatment pathways, expand equitable access to radiotherapy, and ensure that 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 have access to proven, life-saving cancer treatments.
Written by Nare Hovhannisyan, MD