Obstacles to equitable access to diagnostics include the high cost of care and lack of nearby testing centres such as specialist laboratories.
Access to advanced diagnostics is growing in the world’s wealthier countries. Studies show that in high-income countries, treatment for cancer patients diagnosed early is up to four times less expensive compared to treating people diagnosed with cancer at more advanced stages.1
But low- and middle-income countries continue to experience more inequity in accessing medical diagnostics and testing. WHO reports that most people diagnosed with cancer live in low- and middle-income countries, where two-thirds of cancer deaths occur. With cervical cancer, about 90% of new cases and deaths worldwide in 2020 occurred in low- and middle-income countries.2 Less than 30% of low-income countries, however, have accessible diagnosis and treatment services; and referral systems for suspected cancer are often unavailable – resulting in delayed and fragmented care.
According to WHO, only 35% of low-income countries report that pathology services are available in their public health systems (2017), compared to over 95% in high-income countries.3 What are the solutions? The agency calls for all countries to build early diagnosis strategies into their health systems. Direct benefits to the population will be better early-stage cancer detection in patients, enabling treatment that is more effective, less complex and less expensive.
However, inequities can also exist in high-income countries, even those with advanced health systems. In Europe and the UK,
Availability. Limited availability of precision medicine linked to biomarkers.
Assessment. Unclear value assessment approaches for diagnostics that delay moving testing into clinical practice.
Infrastructure. Diverse laboratory infrastructure, capabilities and referral pathways.
Funding. Lack of public funding for biomarker testing limits infrastructure investment and uptake of biomarker testing.
Awareness. Low physician awareness of available tests and their benefits.
Quality. Inconsistent participation of laboratories in quality assurance programmes.
Inequities in diagnostics access also extend to people living with rare diseases. They often have to contend with delayed or incorrect diagnoses due to healthcare professionals having limited knowledge of the disease. Patients and their caregivers also are likely to be unfamiliar with the disease and its symptoms, especially if it doesn't run in the family.
The WHO goal of achieving Universal Health Coverage (UHC) encompasses "the full spectrum of essential, quality health services," and global access to diagnostics is central to achieving that goal.5 This means implementing a strong diagnostics access strategy would extend across disease areas, span the entire patient journey, and have a true global reach.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021:71:209–49. doi:10.3322/caac.21660
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