Highlights
- VENUSCANCER analysed 275,792 high-resolution registry records from 103 registries in 39 countries (2015–18), documenting major global variation in stage at diagnosis, guideline-concordant initial treatment, and time to first treatment for breast, cervical, and ovarian cancers.
- Early-stage diagnoses were substantially more common in high-income countries (HICs) than in low- and middle-income countries (LMICs); in LMICs, fewer than 20% of women with these cancers were diagnosed early in most settings.
- Consistency with international guidelines varied widely by country and modality (e.g., surgery/radiotherapy for early breast cancer: 13% in Georgia to 82% in France), and older age (70–99 years) was associated with lower odds of receiving guideline-consistent initial treatment.
- Time from diagnosis to initiation of treatment ranged from <1 month in several HICs to several months or more in some LMICs (up to 1 year for breast cancer in Mongolia).
Background: disease burden and rationale
Breast, cervical, and ovarian cancers rank among the leading causes of cancer morbidity and mortality in women worldwide. Global initiatives such as WHO’s Global Breast Cancer Initiative and the Cervical Cancer Elimination Initiative have highlighted the twin pillars of earlier detection and equitable access to timely, guideline‑based treatment as central to improving outcomes. Population-based cancer registries that collect high-resolution clinical data (stage, biomarkers, first-course treatment and dates) provide a unique window into real-world patterns of care and the degree to which practice aligns with consensus guidelines (ESMO, ASCO, NCCN).
Study design and data sources
The VENUSCANCER project performed a secondary analysis of anonymised, individual-level records submitted by 103 population-based cancer registries across 39 countries and territories. The dataset included women diagnosed with breast, cervical (including in situ), or ovarian cancer during a single incidence year between 2015 and 2018.
High-resolution data elements captured included tumour stage at diagnosis, staging procedures, tumour grade, biomarkers (ER, PR, HER2 for breast cancer), and the first course of each treatment modality (surgery, radiotherapy, chemotherapy, endocrine therapy, anti‑HER2 therapy) together with treatment dates. The analysis focused on: (1) prognostic factors at diagnosis; (2) concordance of initial treatment with major international guideline recommendations; and (3) interval between diagnosis and first treatment. Analyses compared HICs versus LMICs, and modelled odds of receiving guideline-consistent care controlling for age and tumour subtype.
Key findings
Overall cohort
The analysis included 275,792 individual records: 214,111 (77.6%) breast cancers, 44,468 (16.1%) cervical cancers (including in situ lesions), and 17,213 (6.2%) ovarian cancers.
Stage at diagnosis
In high-income countries (HICs), over 40% of breast and cervical cancers were early-stage and node-negative, whereas fewer than 20% of ovarian cancers were diagnosed early. In contrast, in most low- and middle-income countries (LMICs) the proportion of early-stage, node-negative tumours was generally below 20% across all three tumours, with notable exceptions: Cuba had 30% early-stage breast cancers, and Russia had 36% early-stage cervical and 27% early-stage ovarian cancers. These distributions underscore persistent deficits in early detection in many LMIC settings, particularly for ovarian cancer where early presentation is inherently less common.
Concordance with guideline-recommended initial treatment
There was substantial intercountry variability in whether initial treatments followed international guideline recommendations. Key examples include:
- Early-stage breast cancer (surgery and radiotherapy where indicated): guideline-consistent treatment ranged from 13% (Georgia) to 82% (France).
- Advanced cervical cancer (chemoradiation/chemotherapy as appropriate): concordance ranged from 18% (Mongolia) to 90% (Canada).
- Metastatic ovarian cancer (surgery plus chemotherapy when appropriate): consistency ranged from 9% (Cuba) to 53% (USA).
Overall, some type of surgery was offered to 78% of women in HICs compared with 56% in LMICs. However, when the denominator was restricted to early-stage tumours, adherence to guideline-consistent initial treatment was relatively more uniform for cervical and ovarian cancers than for breast cancer, indicating that modality-specific bottlenecks (e.g., access to radiotherapy, workforce, or complex surgery) may differentially affect breast cancer care.
Age disparities
Older women (aged 70–99 years) had lower odds of receiving initial treatment that aligned with guidelines compared with women aged 50–69 years in both HICs and LMICs. This age-related disparity persisted after adjustment for tumour subtype, suggesting potential under-treatment of older patients due to comorbidity concerns, implicit bias, resource prioritisation, or lack of geriatric oncology integration into treatment planning.
Time to initiation of treatment
Median time from diagnosis to first treatment varied markedly. In several HICs the median interval for early-stage cancers was less than one month. In some LMIC settings the interval was substantially longer: up to 4 months for cervical cancer in Mongolia and for ovarian cancer in Ecuador, and up to 1 year for breast cancer in Mongolia. Delays of this magnitude are clinically meaningful because they can allow disease progression, increase patient anxiety, and may contribute to poorer survival at the population level.
Patterns by tumour type
Cervical and ovarian cancers showed greater uniformity in guideline-concordant initial treatment across settings than breast cancer. This may reflect clearer, resource-tailored algorithms for cervical cancer (where chemoradiation is standard for locally advanced disease) and for ovarian cytoreductive strategies, whereas breast cancer management involves a broader array of modality decisions—multidisciplinary surgery, radiation, systemic therapy, and biomarker-directed treatments—that can be more sensitive to resource availability.
Expert commentary and interpretation
The VENUSCANCER analysis is notable for its scale, using population-based registries with patient-level clinical detail that goes beyond incidence counts to show how cancers are being managed in the real world. The findings have several implications:
- Persistent late-stage presentation in LMICs remains a primary driver of poor outcomes. Improvements in early detection (screening, awareness, and diagnostic capacity) are urgently needed to increase the proportion of women presenting with treatable early disease.
- Substantial intercountry variability in guideline concordance points to health-system constraints (workforce, access to radiotherapy, surgical capacity, chemotherapy supply chains) and to potential gaps in guideline adoption, local adaptation, or measurement.
- Prolonged time-to-treatment in some settings is an actionable quality metric. Streamlining referral pathways, strengthening multidisciplinary teams, and investing in capacity (diagnostic imaging, pathology, operating theatres, radiotherapy) could reduce clinically relevant delays.
- Systematic under-treatment of older women requires attention: geriatric assessment tools, inclusion of older adults in evidence generation, and shared decision-making frameworks could mitigate age-based inequities.
Limitations and generalisability
Although registry-based high-resolution data are a strength, limitations include potential heterogeneity in data completeness across registries, differences in staging or coding practices, and the single-year sampling frame per registry which may not capture temporal trends. The analysis assessed initial treatment only; it does not report on treatment completion, dose intensity, access to targeted therapies beyond anti‑HER2, or long-term outcomes such as survival. Nonetheless, the international breadth and granularity of the dataset make the findings highly informative for health policy and prioritisation.
Clinical and policy implications
For clinicians and health system planners, the VENUSCANCER findings provide measurable targets: increase early detection rates, improve access to guideline-recommended modalities (including radiotherapy and systemic therapies), reduce time-to-treatment intervals, and address age-related treatment disparities. For global initiatives (WHO Global Breast Cancer Initiative; WHO Cervical Cancer Elimination Initiative), these data support targeted investments in diagnostic capacity, workforce training, radiotherapy infrastructure, and implementation of context-appropriate treatment pathways.
Conclusions
The VENUSCANCER project delivers the first global portrait of real-world patterns of care for breast, cervical, and ovarian cancers using high-resolution registry data. While progress has been made in making guideline-consistent treatment more available in some LMIC contexts, the dominant obstacle remains late-stage diagnosis. Concerted action to strengthen early detection, ensure timely access to multimodality care, and reduce inequities by age and geography is needed to translate existing therapeutic advances into improved outcomes for women worldwide.
Funding
European Research Council Consolidator Grant (as reported in the VENUSCANCER publication).
References
1. Allemani C, Minicozzi P, Morawski B, et al.; VENUSCANCER Working Group. Global variation in patterns of care and time to initial treatment for breast, cervical, and ovarian cancer from 2015 to 2018 (VENUSCANCER): a secondary analysis of individual records for 275,792 women from 103 population-based cancer registries in 39 countries and territories. Lancet. 2025 Oct 22:S0140-6736(25)01383-2. doi:10.1016/S0140-6736(25)01383-2.
2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660.
3. World Health Organization. Global Breast Cancer Initiative. WHO; 2021. https://www.who.int/initiatives/global-breast-cancer-initiative
4. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. WHO; 2020. https://www.who.int/publications/i/item/9789240014107
5. European Society for Medical Oncology (ESMO). Clinical Practice Guidelines. https://www.esmo.org/clinical-practice-guidelines
6. American Society of Clinical Oncology (ASCO). Clinical Practice Guidelines. https://www.asco.org/guidelines
7. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. https://www.nccn.org/guidelines
