A Preventable Tragedy 

Despite being largely preventable through coherent healthcare measures, cervical cancer continues to be one of the leading causes of morbidity and mortality among women worldwide (World Health Organization, 2024). In some Central American countries, this striking paradox represents a profound site of health inequality. The persistent nature of the malignancy highlights the absence of life-saving and preventative interventions. As senior students in the School of Health Studies at Western University, working under the supervision of Dr. Nouvet, our ongoing academic research examines patterns of healthcare seeking for diagnosis, treatment initiation, completion, and interruption regarding cancer care among women in Nicaragua. Through this work, we have gained an understanding of how particular systemic barriers lead to worsened health outcomes for women facing cancer. Therefore, to improve the overall quality of care for women affected by cervical cancer, we believe that it is imperative to examine the healthcare systems of Nicaragua, Guatemala, and Honduras, the countries with some of the highest cervical cancer incidence rates in Central America, through a respectful and evidence-based lens (Holme et al., 2020). 

Who Is Left Behind? Disparities in Cervical Cancer Screening and Treatment 

In examining these systems, it becomes clear that the three Central American nations have made significant efforts to strengthen health systems for cervical cancer care, as reflected in the decline in mortality rates over the past decade (International Agency for Research on Cancer, 2022a). However, certain deficiencies within the healthcare systems of these nations remain evident, as the age-standardized incidence rates (ASR) per 100,000 women for cervical cancer are 19.9 in Guatemala, 19.4 in Nicaragua, and 18.8 in Honduras, compared to just 6.6 in Canada (International Agency for Research on Cancer, 2022b). Similarly, the age-standardized mortality rates are 11.0, 8.9, and 14.8 per 100,000, respectively, whereas Canada reports a rate of  2.1 per 100,000 (International Agency for Research on Cancer, 2022b). Numerous social determinants of health contribute to differences in cancer outcomes based on socioeconomic status; significant disparities are the result of fragmentation and underdeveloped health systems. Key documented barriers to timely diagnosis and treatment for cervical cancer in all three countries include: limited access to screening, inconsistent quality of testing, limited infrastructure leading to delayed diagnosis, and fragmented coordination among care subsystems (Holme et al., 2020; Strasser-Weippl et al., 2015).  

These structural barriers disproportionately affect women from disadvantaged backgrounds, particularly those with low income and limited education, as such socioeconomic positions have been observed to deter access to screening and treatment services (Nuche-Berenguer & Sakellariou, 2019).  This disparity is evidenced through the correlation between women from disadvantaged socioeconomic households having sub-optimal knowledge of cervical cancer and an under-utilization of screening services, when compared to their counterparts from more affluent households (Nuche-Berenguer & Sakellariou, 2019). Clearly, financial constraints and limited literacy rates demonstrate that when access to care is dependent on individual initiation, awareness, and proximity to healthcare facilities, women from disadvantaged socioeconomic backgrounds are more susceptible to structural barriers that limit access to timely care. Although similar challenges exist for women in Canada, their impact is largely mitigated, as the country has an organized screening program and stronger follow-up systems that ensure access to preventive care is less dependent on individual resources or awareness (Government of Canada, Public Health Agency of Canada, 2024). 

Progress and Persistent Challenges for Screening 

The structural challenges within the healthcare systems of Nicaragua, Guatemala, and Honduras are reflected in their limited and varying degrees of coordination in cervical cancer screening. Despite investment into cervical cancer screening, practices remain largely opportunistic due to the reliance on Pap smear testing, contributing to “low coverage and minimal measurable impact on incidence and mortality” (Holme et al., 2020). Evidently, cervical cancer screening initiatives exist across Nicaragua, Guatemala, and Honduras, but the reliance on Pap smear-based approaches, which require substantial laboratory infrastructure and trained practitioners, has hindered their overall effectiveness in low- and middle-income countries (LMICs). Commendably, the three countries have begun transitioning toward HPV-based testing; yet, the need for a database to monitor and recall patients for regular screening remains evident, as in Honduras and Nicaragua, only 58.8% and 67.1%, respectively, of women with a positive triage test ultimately received treatment (Holme et al., 2020). Although the adoption of HPV-based testing represents a substantial step in the right direction, with Guatemala even implementing a preliminary screening program, the absence of an organized national screening program accompanied by a comprehensive database continues to promote an opportunistic approach to cervical cancer treatment. As a result, women residing in rural and low-income settings remain at a significant disadvantage, as many of them remain unaware of the importance of early detection and the consistency of following appropriate screening intervals, allowing preventable cases to progress into advanced stages, thus leading to unfavourable health outcomes for women. 

Bridging Gaps: Health System Fragmentation and Workforce Shortages 

To further understand the systemic barriers contributing to poor cervical cancer outcomes, it is essential to examine the fragmented nature of Nicaragua, Guatemala, and Honduras’ health systems. Fragmentation is the result of multiple healthcare delivery subsystems which provide care to different groups, inequities in financial support to these subsystems, and a shortage of trained healthcare professionals. Each country reports fewer than 40 healthcare workers per 10,000 people, while Canada reports around 125 healthcare workers per 10,000 people, a stark disparity that highlights the availability of healthcare workers between high- and low-income settings (World Health Organization, 2022–2025).  

Nevertheless, the governments of Nicaragua, Guatemala, and Honduras have shown a strong commitment to improving their national healthcare systems by participating in regional data collection initiatives (World Health Organization, 2022–2025). However, the ongoing shortage of healthcare professionals, along with structural fragmentation, leads to substantial inequities in access to and quality of cancer screening, testing, and treatment. Often, high-quality services are found within the private healthcare sector and thus used by women in the upper echelons of the societal hierarchy. Consequently, women who rely on the public systems may face significant challenges stemming from a limited workforce and a shortage of supplies, leading to potentially inaccurate Pap testing. This further perpetuates the cycle of late diagnosis and ineffective treatment, as substandard screening may result in false negatives or the failure to detect early precancerous signs. Hence, the notion that status and income level determine the quality of care, rather than medical necessity, is reinforced. 

Change Is Needed: Structural Reform and Cultural Sensitivity 

The persistent nature of cervical cancer in Nicaragua, Guatemala, and Honduras serves as a reminder of not only the challenges associated with the region’s healthcare systems but also of the broader global health disparities that continue to affect women’s access to care. Despite the disease being largely preventable, the absence of a fully organized national screening program, fragmented healthcare systems, and a shortage of healthcare professionals have collectively hindered early detection and effective treatment. Undoubtedly, the Central American nations being examined are making continuous efforts to improve their healthcare system by expanding HPV based testing and engaging in data collection efforts to address the shortage of workforce; however, the conjunction of these systemic gaps disproportionately impacts women of lower socioeconomic status as they often suffer from exclusion, diminished continuity of care, and potentially poor quality of testing and treatment. Furthermore, cultural barriers may add another layer of complexity that further complicates the challenges associated with equitable care and treatment, as they discourage women from seeking preventative care. Such barriers often stem from systemic limitations, which may perpetuate misinformation, stigma, and distrust among women. Indeed, limited education and awareness regarding cervical cancer can further amplify socioeconomic and systemic factors, limiting women’s willingness and ability to seek timely care. As such, it is clear that structural reform and culturally informed interventions remain key in promoting equitable cervical cancer prevention and treatment.  

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