Radiotherapy, although an essential and cost-effective treatment for cancer, has a low uptake on the African continent. Common cancers treated in the region need radiotherapy as a component of therapy at some point in the course of the management of their disease. Within Africa, around half of the countries have no radiotherapy services and most of those that have cannot adequately cover the population which needs them.

To redress inequitable access, advocacy at all levels is needed for acceptance of radiotherapy and the important role it plays in cancer control. The relatively high cost of setting up radiotherapy services needs to be balanced with the long-term benefits of having a well-proven treatment modality that can be accessible to a large number of cancer patients at reasonable cost. Low healthcare funding in the region is a possible hindrance to access to radiotherapy.

Consideration of the appropriateness of technology to be procured when setting up such facilities is important. It should not, however, be simply a case of gamma versus photon teletherapy. The level of training of staff, quality evidence-based treatment provision and infrastructural considerations need to be taken into account. Where facilities are available, low radiotherapy utilisation rates are common and should be corrected. Good practice regarding quality assurance is important. Local research to test regional and adopted practices should be promoted to provide local evidence.

Conclusions: With an imminent cancer epidemic, the scarcity of radiotherapy facilities in Africa is a cause for concern. The measures to correct this should include a multipronged approach that addresses specific needs for individual countries. Radiotherapy is an essential, cost-effective treatment for cancer and its availability must be given priority alongside the management interventions for other common diseases and conditions.