Mapping country-level structural capacity constraints in brachytherapy infrastructure for locally advanced cervical...

To develop a reproducible public-data method for mapping country-level capacity constraints in brachytherapy infrastructure relevant to guideline-concordant treatment for locally advanced cervical cancer across the Americas, comparing expected disease-stage-specific need with reported brachytherapy unit counts.

We performed a cross-sectional ecological study at the country/territory level. Incident cervical cancer cases among females in 2022 were taken from GLOBOCAN-derived extracts and were linked with radiotherapy infrastructure data from the International Atomic Energy Agency DIrectory of RAdiotherapy Centres for countries in the Americas. Expected locally advanced cervical cancer cases were estimated as 37.0% of incident cervical cancer cases; 25.8% and 52.1% were used as low-high sensitivity bounds. The primary metric was expected locally advanced cervical cancer cases per DIrectory of RAdiotherapy Centres-reported brachytherapy unit. Countries or territories with zero reported units, no DIrectory of RAdiotherapy Centres data available, or unavailable cancer burden data were classified separately. Countries with at least 1 unit and available burden data were grouped into quartiles of estimated capacity constraints.

The combined public-data register contained 37 unique countries/territories in the Americas region: 34 with cervical cancer burden data and 33 with DIrectory of RAdiotherapy Centres infrastructure information. Thirty countries/territories had both burden and infrastructure data; 29 had at least 1 reported brachytherapy unit. In the primary linked set, there were 77,764 incident cervical cancer cases, 28,773 expected locally advanced cervical cancer cases, and 1060 reported brachytherapy units. Among countries/territories with at least 1 unit, the median number of expected locally advanced cervical cancer cases per unit was 59.6 (interquartile range; 30.0-112.8) for 2022 data. The highest measurable capacity constraints occurred in Honduras (169.5), Paraguay (137.5), Nicaragua (133.4), Ecuador (132.6), and Guatemala (130.3). Central America had the highest regional capacity constraints (116.8), followed by South America (61.2), the Caribbean (53.0), and North America (12.7).

Public-data analysis can identify plausible structural infrastructure capacity-constraint signals relevant to cervical cancer management in the Americas. The metric should be interpreted as indicating hypothesis-generating potential infrastructure capacity constraints, not patient-level treatment receipt, treatment quality, or operational capacity. The next phase should validate DIrectory of RAdiotherapy Centres data, geocode centers, model travel time, and link to patient-level treatment and outcome data where feasible to improve the capacity analysis.