Dear IGCS Members,
EARTH DAY is observed annually on 22 April in support of environmental protection. On this Earth Day, I invite you to reflect with me on the connection between the health of our planet and our mission to improve the lives of those affected by gynecologic cancers: now and into the future.
SOCIAL SUSTAINABILITY
You may remember that we announced as one of the priorities for my term as IGCS President, the improvement of both accessibility and sustainability of cancer surgery and care. But how do these two concepts relate to each other and to the wellness of our planet? The three pillars of sustainability are: social, environmental and economic and they are interdependent and all equally important.
Social sustainability emphasizes equity and justice, which in healthcare means: access to quality, affordable treatment for all. Our Society has already played an important role to improve accessibility by increasing skilled health workers globally via the surgical and radiation training programs. Understanding the importance of quality care for everyone, at IGCS we continue to focus on education and expand our training programs. Another key aspect of social sustainability demanding our attention is affordability; also crucial for economic sustainability.
ENVIRONMENTAL SUSTAINABILITY
The environmental impact of cancer treatment, including surgical, radiation, or medical, is substantial and requires urgent consideration. Considering the waste footprint, a single surgery can produce several pounds of waste, including disposable single-use items, packaging waste, and biohazard waste. Chemotherapy treatment rooms also have to dispose of cytotoxic biohazardous waste. Proper separation, treatment and disposal to protect the public and environment is difficult and expensive - most low-income countries do not have proper facilities, and up to 40% hospitals worldwide do not separate waste. Medical waste often ends up in landfills, where non-biodegradable waste takes hundreds of years to break down. Some high-income countries even ship waste which includes plastics and hazardous materials to low- and middle-income countries (LMICs) for disposal or recycling. This practice raises serious ethical and environmental concerns.
Regarding the carbon footprint of our industry, it is clear that minimally invasive surgery generally has higher greenhouse gas emissions than open surgery, and robot assisted surgery even much higher. A recent review showed that a typical single robotic case has a footprint similar to a 3658km car trip! Important drivers are: production and packaging of single-use instruments, energy use, CO2 pneumo-peritoneum, anesthesia gases, and waste disposal. The electrical energy needs of imaging and radiation treatment are also very substantial and must be attended to.
ECONOMIC SUSTAINBILITY
Economic sustainability requires that we balance financial profitability with affordability and accessibility (social justice), and ‘acceptable’ ecological impact (environmental sustainability). Eventually the well-being of our planet, humanity and other living species are essential for the security of industry itself.
It is accepted that public healthcare delivery is not profitable, but now high medical inflation challenges the delivery of quality care even in the highest income countries. Drivers of cost include growing and aging populations, higher minimum standards and increased demands for healthcare, but also scientific and technological advances. While environmentally sustainable practices are generally cheaper, it is difficult to resist innovative technologies, convenience, and aggressive marketing. But more affordable practices will grant broad-based access to care and help curb medical inflation.
CALL TO ACTION
At IGCS we pay attention to social sustainability through equity, and equip healthcare workers in LMICs with skills and knowledge. But learning flows both ways. Now that it is time to seriously consider the global needs for sustainability, colleagues from high-resource countries (HICs) can - and should - learn from settings where constraints demand more thoughtful and efficient use of materials. Ideally, we can all adopt more maintainable approaches that improve environmental stewardship and affordability.
The theme of Earth Day 2024: “Planet vs. Plastics” calls attention to the immense dangers of plastic pollution, which links with our waste footprint. The WHO waste-management hierarchy (2014) is to firstly avoid generating waste, and secondly to recover waste items that can have a secondary use. This is a call to action against convenient single-use items, towards re-using and recycling, but also to advocate for better waste management wherever we live and work. Optimal waste treatment happens at the facility, and uses low-heat thermal processes like autoclaves and microwaves, or modern incinerators.
The theme for Earth Day 2025: “Our Power, Our Planet” urges everyone to attend to generation and use of power, and to reduce our carbon footprint. The power use and carbon footprints of medical and surgical procedures and equipment differ, showing that we can positively impact emissions by becoming better informed and by clever choices. And we must advocate for greater attention to the carbon footprint of technologic advances before these are implemented and recommended.
The shift toward sustainability may not be in the hands of individual clinicians, but our voices as opinion leaders matter in convincing companies and hospitals to pay more attention to this metric. Health innovations should demonstrate not only improvements in measurable health outcomes, but also their environmental impact. Sustainability is everyone’s problem and there are numerous daily and professional choices that each of us make which collectively can contribute to a healthier planet while advancing our shared mission to provide life-saving care to those affected by gynecologic cancers.
We have a responsibility not only to our patients, but also to the world we live in today and to sustain this one earth for future generations. I will be sharing more on this important topic and welcome your feedback, ideas, and experiences.
Sincerely,

Prof. Greta Dreyer
President, International Gynecologic Cancer Society (IGCS)