Breast cancer: your (poor) SA options

210307 Dr Mick van Binsbergen looks at mammogram xray pictures in Ellen Joseph hospital. Picture Ilvy Njiokiktjien

210307 Dr Mick van Binsbergen looks at mammogram xray pictures in Ellen Joseph hospital. Picture Ilvy Njiokiktjien

Published May 21, 2013


Johannesburg - Actress Angelina Jolie has announced that she has a gene that made her more susceptible to cancer, so she’s decided to undergo a preventive mastectomy.

But while the Hollywood superstar can afford such preventive breast cancer treatment, in South Africa it can take between six and nine months for a patient just to get diagnosed in the public health sector – thanks to a lack of resources and education, according to Lauren Pretorius, chief executive of the Campaign For Cancer.

In this country, where only 17.6 percent of people had medical aid coverage in 2010, according to StatsSA, that affects most South Africans who are forced to rely on public clinics and hospitals.

“The costs (of private cancer health care) are prohibitive to anyone who doesn’t have medical aid,” said Noelene Kotschan, founder and director of Pink Drive. In private care, breast cancer treatment could cost between R750 000 and R1.5-million, depending on what was required, Pretorius said. But because there were only eight public hospitals with breast clinics, and even fewer with genetic testing, access to breast cancer care and diagnosis was difficult.


Breast cancer survivor Ntokozo Dludla, who has now been cancer-free for the past five years, experienced the challenges first-hand.

She discovered a lump in her breast while living in Durban, and consulted two private doctors. The first told her to wait six months and see if the lump went away, while the second made her wait a week before telling her she had breast cancer. “I went to the doctor asking, ‘Can you help me?’ because I knew something was wrong, even though I didn’t know anything about breast cancer,” the community educator for the Breast Health Foundation said.

Frustrated by the lack of information and options offered by doctors, she decided to seek treatment in Joburg. At Helen Joseph, she paid only R35 per round of chemotherapy.

Dludla, 40, said people who went to public hospitals seeking answers were playing a game of pot luck, since so many doctors were not adequately prepared to make a breast cancer diagnosis.

Barbara Ruiters, of the Democratic Nursing Organisation of South Africa, said that even most nursing institutions did not focus on breast cancer. So only the few nurses who specialised in breast cancer would be able to diagnose it.


According to the 2004 National Cancer Registry, one in 29 women will develop breast cancer. But it wasn’t compulsory for doctors to report cases of breast cancer until a change in health law last year, so this figure could be a significant under-estimation, warned Cancer Association of South Africa (Cansa) clinical specialist Magdalene Seguin.

Dr Jenny Edge, a breast surgeon at Christiaan Barnard Memorial Hospital in Cape Town, agreed: “We don’t have current statistics about the prevalence of breast cancer in South Africa, and no idea how many women are left undiagnosed and untreated.”

Pretorius said there was no national policy on breast cancer, although the Department of Health recently created a task force to develop a policy with cancer NGOs.

Cansa advocated that women receive mammograms every year after the age of 35, Seguin said.

But Pretorius said that annual screenings were not possible in the public sector. “We’re having a lot of undiagnosed cases, and when they’re diagnosed, it’s very late,” she said. “But if we have to do screenings in the public system, as it is now, the system cannot handle it.”


Cansa and Pink Drive brought mammograms and awareness to communities, Kotschan said. Pink Drive educated about 150 to 200 women a day, advising them to conduct self-examinations to find breast lumps early.

Dludla suggested that companies and the government begin a breast cancer awareness campaign similar to that for HIV/Aids. - Saturday Star

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