World Journal of Surgery

, Volume 43, Issue 9, pp 2203–2210 | Cite as

Estimating the Global Demand and Delivery of Cancer Surgery

  • Syed Nabeel ZafarEmail author
  • Asif H. Siddiqui
  • Roomasa Channa
  • Shayan Ahmed
  • Ammar A. Javed
  • Andrea Bafford
Original Scientific Report



Cancer is a leading cause of death and disability globally. While surgery remains a vital part of cancer management, access to surgical care remains inconsistent. Our objective was to estimate the global need for cancer-related surgery and to identify disparities in the surgeon workforce.


The World Health Organization International Agency for Research on Cancer and the Global Cancer Observatory were queried for estimates on national incidences of 35 different malignancies. The proportion of patients requiring surgery for each of these cancers was extrapolated from the United States Surveillance, Epidemiology and End-Result database. The number of people requiring cancer surgery in each country was calculated and compared with the surgical workforce. Estimates were presented as choropleth maps. Associations were tested with country development indicators.


An estimated 9,464,214 (95% CI 4,364,196–14,564,230) patients required cancer-related surgical care in 2018. An overall 1.24 people needed cancer surgery per 1000 population. This was related to income status (p < 0.01) and Human Development Index (r = 0.86, p < 0.001), with the largest need being in high-income countries. The number of people requiring cancer surgery per surgeon (CP–S ratio) ranged from 7.3 in the European region to 80 in the African regions. The CP–S ratio was 10 times higher for low- versus high-income countries (p < 0.001) and was inversely related to healthcare expenditure (r = −0.59, p < 0.001).


An estimated 9.5 million people required cancer surgery globally. Low- and middle-income countries experience a severe and acute shortage of surgeons to provide for the cancer surgery needs of the population.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

268_2019_5035_MOESM1_ESM.docx (89 kb)
Supplementary file1 (DOCX 89 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of MarylandBaltimoreUSA
  2. 2.Department of Surgical OncologyMD Anderson Cancer CenterHoustonUSA
  3. 3.Department of SurgeryAga Khan UniversityKarachiPakistan
  4. 4.Department of OphthalmologyBaylor College of MedicineHoustonUSA
  5. 5.Dubai Health AuthorityDubaiUAE
  6. 6.Johns Hopkins School of Public HealthBaltimoreUSA
  7. 7.Division of Surgical Oncology, Department of SurgeryJohns Hopkins Medical InstituteBaltimoreUSA

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