Globally, a polarised epidemiological transition is occurring in cancer, generating a divide that reflects the inequity in access to all components of cancer care and control, now referred to as the cancer divide. Attempts to address the challenges these inequities create should acknowledge and incorporate inherent differences in disease burden, culture, and resources across the world (appendix pp 1–2). In high-income countries (HICs), increasing centralisation of cancer care in tertiary, or even supraregional, centres will further enhance access to high-quality surgery, diagnostics, radiotherapy, systemic therapies, and new technologies, which can offset their cost. In low-income and middle-income countries (LMICs), the focus should be on establishing facilities to offer basic cancer prevention and care, with an emphasis on accessibility. Over 5 billion people, predominantly in LMICs, do not have access to basic surgical procedures,1 diagnostics, pathology, radiotherapy, and even generic chemotherapies, reflecting a growing chasm in global cancer care between HICs and LMICs.