Bolivia to Strengthen Cancer Control Systems Based on Review Mission Recommendations

Bolivia has taken a critical step towards strengthening its cancer control system by hosting an imPACT Review mission led by the IAEA, the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC). Over the course of ten days in August, national and international experts conducted a thorough evaluation of Bolivia's cancer care infrastructure, from prevention to diagnosis to treatment to palliative care, focusing on current gaps and areas for development.

Bolivia's increasing cancer burden - in particular for cervical cancer, for which Bolivia has one of the highest incidence rates in the region (22 per cent of all female cancer cases), but also for prostate and breast cancers (25 per cent of male and 17 per cent of female cases respectively) - underscored the urgency of the mission (Globocan 2022). Despite efforts to decentralize cancer services and enhance cooperation among health subsystems, infrastructure and human resources remain concentrated in the country's main cities (La Paz, Santa Cruz and Cochabamba). This centralization restricts access to cancer services, presenting ongoing challenges to achieving equitable care nationwide.

Cervical cancer was a central focus of the review due to its high incidence in Bolivia. While the government has made significant progress in expanding human papillomavirus (HPV) vaccination and screening programmes, which protect against cervical cancer, the imPACT team urged further expansion of high-accuracy HPV testing and increased awareness and access to the vaccination in underserved areas. The integration of cervical cancer screening with other cancer control efforts was recommended to enhance coordination and improve patient outcomes.

"Addressing cervical cancer must remain a national priority given the high incidence in Bolivia," said Vice Minister Mariana Ramírez in her remarks at the end of the mission. "Expanding access to early screening and HPV vaccination is essential for saving lives," she added.

For all cancer types, major efforts have been made to purchase the technology needed to ensure the quality and timeliness of diagnosis and treatment services across the country, but the distribution of infrastructure, technology and human resources in the public cancer care system remains uneven. Patients face long delays, extended waiting lists and may be forced to travel to the capital to receive adequate diagnosis and treatment. A key recommendation of the imPACT Review was therefore to establish agreements between health subsystems to optimize the use of diagnostic tools and medical equipment. Investments in radiotherapy and nuclear medicine were also deemed critical, as many cancer patients lack access to essential treatment options. Ensuring regular maintenance and the modernization of equipment was recommended to help the country maintain high-quality care standards.

"Improving the efficiency and capacity of Bolivia's diagnostic and treatment systems is not only urgent but feasible," said Ramírez. "By maximizing the use of available resources and investing in the necessary equipment, we can significantly reduce the burden of cancer in the country."