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.

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