Brachytherapy infrastructure in sub-Saharan Africa and quest for cervical cancer elimination

Purpose: Sub-Saharan Africa has the highest burden of cervical cancer in the world. The African continent has only 5% of the world's cancer care resources, and brachytherapy is an important part of treatment of cervical cancer. This study explored the availability of brachytherapy units in Africa. Material and methods: We used publicly available data on cervical cancer and brachytherapy from GLOBOCAN 2018 database hosted by IARC and Directory of Radiotherapy Centers (DIRAC) presented by IAEA, respectively. Number of brachytherapy units per 1,000 new cases was calculated as an index for comparison between groups. Results: There are 101 brachytherapy units in 20 African countries, accounting for 3% (101/3,375) of total global units. Sub-Saharan Africa accounts for half of these units (50/101). Egypt has the highest number of units per 1,000 new cases (23.7 units/1,000 new cases), while Nigeria has the least with 0.13 units per 1,000 new cases. No country in central African region has a brachytherapy unit. More than 70% of brachytherapy units are located in five countries (Algeria, Kenya, Egypt, Morocco, and South Africa). Conclusions: In order to treat 90 percent of invasive cervical cancer on the continent, Africa needs a continental political action plan and massive investment in brachytherapy equipment over the next ten years.