South Africa: SA’s Breast Cancer Care System Is Failing Too Many Women

A study by the Department of Surgery at the University of Cape Town (UCT) and Groote Schuur Hospital has revealed deep systemic inequities in breast cancer care across South Africa. This includes critical shortages of surgical services, specialist staff and diagnostic capacity, leaving many women without access to life-saving treatment.

Published in the South African Medical Journal, the study provides the first national snapshot of breast cancer surgical services in the public sector, analysing data from 43 hospitals across all nine provinces. It examined the availability of surgical treatment and the factors influencing whether patients receive guideline-based care.

The study found disparities in service provision across healthcare settings, with resource constraints and uneven distribution of services limiting access to guideline-concordant surgical care.

Breast cancer is one of the most common cancers among women in South Africa, yet outcomes remain worse than in higher-income countries, partly because of barriers to timely and appropriate treatment.

“This is not just a clinical issue – it reflects systemic barriers to early diagnosis and access to care.”

“There is an urgent need to address the deficits in the distribution and capacity of breast cancer surgical services in South Africa, and to close the gap between policy and implementation,” said Dr Laurie Milligan, a global surgery researcher at UCT and the study’s lead author.

At the centre of the crisis is late diagnosis. The study found that around 67% of patients present with advanced-stage disease, a figure that significantly reduces survival chances and limits treatment options.

“Two-thirds of patients are arriving with advanced breast cancer, and by that stage, outcomes are already much poorer. This is not just a clinical issue – it reflects systemic barriers to early diagnosis and access to care,” said Dr Milligan.

Findings

The study showed that breast cancer surgical services are heavily concentrated in urban centres, forcing many patients – particularly in less urban provinces – to travel long distances for diagnosis and treatment. This geographic inequality is closely linked to delayed care and worse outcomes.

“Where you live in South Africa still determines the quality of care you receive,” said Milligan. “Patients in less urban provinces face significant barriers, from limited diagnostic tools to fewer specialist services. These delays can be fatal.”

While basic diagnostic tools such as biopsies and mammography are widely available, more advanced technologies, including MRI, PET scans and specialised localisation techniques, remain out of reach for many facilities.

Encouragingly, the majority of facilities report the ability to perform breast-conserving surgery. However, access to more specialised procedures remains limited.

“It’s not enough to provide surgery, it has to be the right surgery, delivered as part of a comprehensive treatment plan.”

Only about half of hospitals can perform sentinel lymph node biopsy, a key procedure that reduces complications compared to more invasive surgery. Even fewer, just 35%, offer breast reconstruction, leaving many women without options that are considered standard in comprehensive cancer care.

“These gaps matter,” said Milligan. “It’s not enough to provide surgery, it has to be the right surgery, delivered as part of a comprehensive treatment plan.”

Uneven access

The study also found uneven access to critical medicines. While hormonal therapies are widely available, targeted treatments such as trastuzumab – essential for certain aggressive breast cancers – are accessible in only a minority of facilities.

Beyond infrastructure, the study highlights a critical shortage of skilled healthcare professionals. Multidisciplinary teams, the backbone of effective cancer care, are inconsistently available, and very few facilities meet national staffing recommendations for specialist breast units.

Milligan said: “Breast cancer care requires coordination between multiple specialists, from surgeons to oncologists to radiologists. In many facilities, those teams simply don’t exist in full. That limits what care can be offered, even where basic services are available.”

The lack of support services, including psychology, social work and palliative care, further compounds the burden on patients navigating an already complex system.

While the average waiting time for surgery is reported at 28 days, within national guidelines, the study suggests that the most significant delays occur earlier, before patients even reach specialist care.

“Improving early detection and referral systems could dramatically change outcomes.”

Previous research showed that patients can wait months between first noticing symptoms and receiving treatment, often making multiple visits to primary healthcare facilities before being appropriately referred.

“We are seeing a bottleneck before patients enter the surgical pathway,” noted Milligan. “Improving early detection and referral systems could dramatically change outcomes.”

South Africa’s Breast Cancer Prevention and Control Policy set out a clear framework for standardised, high-quality care, including the development of specialist breast units. However, the study found that these guidelines remain largely unimplemented across the public sector.

“There is no shortage of policy. The challenge is implementation,” she said. “Without investment in infrastructure, staffing and training, these guidelines will remain aspirational rather than operational.”

A clear roadmap

According to Milligan, the findings provide a clear roadmap for strengthening breast cancer care in South Africa. “Priorities include expanding access to diagnostic and staging technologies, increasing surgical capacity, building multidisciplinary teams and improving referral pathways to ensure earlier diagnosis,” she said.

“Breast cancer outcomes can be improved, but it will require coordinated action across the health system to close the gap between what is possible and what is currently being delivered.”

By UCT.