Cancer mortality is spatially uneven in Ecuador, yet the contribution of oncology equipment to this pattern is unclear. Cross-sectional data for 221 municipalities in 2020 linked mortality to seven predictors: the municipal share of specialized devices, an operational-capacity index, health-sector value added, population density, gross value added per capita, economic inequality, and provincial-capital status. Ordinary-least-squares models estimated the average technology effect, its interaction with capacity, and its interaction with inequality; robustness was assessed after excluding Quito and Guayaquil. Technology displayed a positive but non-significant association with log-mortality. The interaction between technology and capacity was negligible. By contrast, the technology and inequality interaction term was negative and significant, and the direct technology coefficient in the reduced sample, confirming that benefits accrue mainly to wealthier jurisdictions. Health-sector participation remained a strong positive predictor, suggesting referral clustering rather than service inefficiency. Oncology technology behaves as a necessary but insufficient input; without equitable financing, skilled personnel, and maintenance, additional devices fail to reduce mortality and may widen territorial disparities.