Worldwide differences in care for female-specific cancers

Large international study: Cancer care for women not always in line with guidelines

For cancers that occur specifically in women (breast, cervical or ovarian cancer), there are major global differences in stage at diagnosis and treatment. Factors such as socioeconomic status, level of education, distance to treatment centres and availability of facilities such as radiotherapy play an important role in the type of care women receive. This also applies to countries with well-developed healthcare systems, where policy and insurance structures can determine access to optimal treatment.

Key findings

• In high-income countries, cancer was detected early in 40% of women, compared with less than 20% in low- and middle-income countries.
• Ovarian cancer is the least likely to be diagnosed early worldwide (less than 20%).
• Three-quarters (78%) of women in high-income countries and more than half (56%) of women in low-income countries were offered surgery, but international clinical guidelines were not consistently followed worldwide.
• Treatment of older women deviated more often from clinical guidelines compared with younger women, both in high- and low-income countries.
• In most low-income countries, women with all three cancer types faced longer waiting times for surgery after diagnosis.

Sabine Siesling, principal investigator in the Breast Cancer team at IKNL, Professor of Personalised Cancer Care at the University of Twente, and co-author of the article in The Lancet, says: “This study clearly shows that cancer care for women worldwide is not always aligned with international guidelines. Because we have a strong infrastructure and reliable data from the Netherlands Cancer Registry (NCR), we can contribute to these international studies and learn from global differences to further improve our own care.”

The Netherlands as both an example and a learner

Although the completeness and quality of data sources may differ between countries, the study shows wide variation in stage at diagnosis and adherence to guidelines. Comparisons were made using the United States as a reference country.

Siesling explains: "There are major differences between countries in achieving early diagnosis and following international treatment guidelines. In the Netherlands, for example, around twenty percent of patients with a small breast tumour undergo mastectomy, which is comparable to the situation in Norway. Chemotherapy and antihormonal therapy are used slightly less often in breast cancer treatment in the Netherlands than in the United States, with usage levels similar to those in Switzerland. In the Netherlands, the benefits and drawbacks of these systemic treatments are carefully weighed, and shared decision-making with the patient may lead to the choice not to pursue treatment.

For gynaecological cancers, patient numbers are much smaller, making international comparisons more difficult. The treatment of metastatic ovarian cancer, however, appears to be similar to that in other high-income countries.

International collaboration and comparison help us better understand where the Netherlands stands, where improvements can be made, and where other countries can learn from us. By comparing the effects of screening programmes and continuing to share data, we can further tailor cancer care worldwide to the individual woman – with the goal of providing optimal, personalised care.”

About the Netherlands Cancer Registry (NCR)

The NCR is a national database containing reliable data on all patients with cancer in the Netherlands. The database is managed by the Netherlands Comprehensive Cancer Organisation (IKNL). Data from the NCR are used for scientific research into cancer and its treatment. This leads to improved treatment of the disease and better care for people with cancer. The data help to continuously improve care for current and future patients.

More information about this study
For more information, data or interview requests, please contact Marjon Kranenbarg, Press Officer at IKNL:
m.kranenbarg@iknl.nl or +31 6 14 71 74 24.