Cancer equity for women demands city-level solutions

Women in low- and middle-income countries face a far higher cancer mortality rate than those in high-income countries. City-led,

gender-responsive action can close the gap and drive global change.

Persistent inequities mean access to cancer care is often determined by where women live. Photo: City Cancer Challenge

A staggering 72% of women in low human development index (HDI) countries die prematurely of cancer, compared to just 36% in high-HDI countries. This disparity is not rooted in disease biology but reflects embedded systemic inequities in healthcare. These inequities span every stage of a woman’s cancer care journey, from the way sex and gender influence exposure to cancer risk factors, to the differences experienced through interactions with healthcare systems, and the biases embedded in healthcare and cancer workforces.

At City Cancer Challenge (C/Can), the 2023 Lancet Commission on Women, Power, and Cancer became a clear call to action. It pushed global health systems to move beyond treating women as merely patients and instead recognising women through their broader societal roles as caregivers, providers, decision-makers, and economic drivers. We asked ourselves: What does this mean for our cities? How can we translate bold global recommendations into city-level impact for women across low- and middle-income countries (LMICs)?

The result: our women and health strategy, an evidence-based framework to embed equity into the core of our co-developed cancer care solutions across all regions. This is not a one-size-fits-all approach. It is rooted in the realities of women across geographies where we work.

Three perspectives, one from each region, highlight the specific barriers women face and how C/Can is putting the women and health strategy into action by responding with context-appropriate action.

Africa: Working with women for women

Across Africa, women carry the weight of cancer—not only as patients, but as caregivers, community health workers, and informal providers of support. Yet these contributions remain undervalued by formal systems, while women face disproportionate barriers to care shaped by time poverty, social norms, and structural gaps. 

In Kumasi, Ghana, breast and cervical cancers are the leading causes of cancer deaths among women, with 70% of breast cancer cases diagnosed late and fewer than 4% of women screened for cervical cancer every three years. Combined with late referrals, diagnostic bottlenecks, and fragmented care, these issues have long left women facing poorer outcomes that ultimately rob families, communities, and the national economy of their most vital contributors.

At C/Can, during the first cycle of programme implementation through our City Engagement Process, we have worked with 578 local stakeholders from 25 institutions to develop targeted programmes that help address the most urgent needs. We have begun creating a digital laboratory network linking public and private laboratories to speed breast and cervical cancer diagnoses, developing nationally endorsed clinical guidelines and treatment protocols to standardise quality care, and invested in specialist training so that Ghanaian clinicians bring back expertise from world-leading cancer centres.

Moving forward, under the framework of the World Health Organization (WHO)-led Global Breast Cancer Initiative, we are deepening our work in Kumasi to include upgrading diagnostic infrastructure. Recognising the Government of Ghana as key facilitator for such programmes, together with local stakeholders we are supporting efforts to apply the lessons learned in Kumasi as a blueprint for shaping wider strategies beyond Ghana, with the goal of reducing breast cancer mortality across Africa.

Latin America: Closing the leadership gap 

Across Latin America, women form the backbone of cancer care yet remain underrepresented in leadership. Patriarchal norms continue to shape who rises in health systems, mirroring a global pattern in which women, despite making up 65–70% of the health and social care workforce, hold only about a quarter of senior roles.  This gap persists despite women surpassing men in tertiary education in most countries, pointing to systemic barriers such as gendered family responsibilities, workplace bias, and a tendency for women to apply for leadership only when feeling they meet all necessary requirements. 

Targeted leadership development can help close these gaps. At C/Can, we have worked with the American Society of Clinical Oncology to develop a leadership programme for women in oncology that equips mid-career women oncologists from the region to lead transformative change in cancer care. Over two years, participants strengthen leadership, communication, and influencing skills through one-on-one mentorship by accomplished national leaders.

The outcomes speak for themselves: participants have advanced as leaders, driven meaningful change within their institutions, and inspired wider impact across their communities, showing that equipping women with the right tools fuels progress well beyond individual careers. 

Asia: Economic imperative and breast cancer

Asia accounts for roughly half of global cancer cases, with breast cancer making up about 45% of cases and mortality on the rise. In Cambodia, where breast cancer is the leading cause of cancer death in women, high out-of-pocket costs—60% of total health spending—force treatment abandonment, financial hardship, and reduce national productivity. These trends underscore the importance of focusing C/Can’s regional efforts on breast cancer within Asia’s evolving epidemiological landscape.

In Phnom Penh, C/Can’s Health System Coordination and Management project channels city-level innovations into national policy closely aligned with Cambodia’s new National Cancer Control Plan (2025–2030), strengthening strategic planning and building referral systems to ensure continuity of care for women with breast cancer so no patient is lost. This includes a City Breast Cancer Action Plan to translate the WHO-led Global Breast Cancer Initiative into measurable action.

At C/Can, we are now also generating Cambodia’s first comprehensive data on cancer-related out-of-pocket costs. These insights will guide policies to reduce financial risk, align social protection programmes with patients’ needs, and ensure that cancer care is not only better connected, but also equitable and financially accessible.

Local action for global change

Women’s cancer care is not a cost to contain—it is a lever to unlock broader health equity. At C/Can, we are embedding gender-responsive approaches across our whole model. This means that we are not only improving outcomes for women; we are building stronger, more inclusive health systems for all. From data and leadership to service delivery and system design, our cities are shaping solutions that are locally grounded, owned by stakeholders, and scalable globally.

The future of equitable cancer care is already in motion and women are driving it. But it starts by recognising women as more than patients. At C/Can, we are committed to recognising the power, potential, and priorities of women across the cities we serve and turning bold global recommendations into practical, city-level, systemic change.

Because where a woman lives should never determine whether she lives.

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The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.

Isabel Mestres is CEO of City Cancer Challenge (C/Can), which supports cities to lead transformational change in cancer care from the ground up. With more than 20 years of experience in global health, she champions the belief that quality care is a right, not a luxury, advancing equitable, locally-driven solutions that strengthen health systems worldwide.

This article reflects the perspectives and expertise of C/Can’s regional directors for Africa and Europe, Latin America, and Asia: Sophie Bussmann-Kemdjo, Maria F. Navarro, and Chika Kitajima.