When Nokwanda* was diagnosed with breast cancer in 2023, she thought it was a death sentence.
The 30-year-old from Ngqeleni in the Eastern Cape says she had never even heard about cancer before her diagnosis.
“I went to the hospital because I had a growing lump in my left breast. I was told I would be referred for further investigations through a mammogram, a word I had never heard before,” she said.
But getting that scan was not simple.
She had to travel to East London, about two hours away, and waited three months for an appointment. By the time she was diagnosed, the cancer was already aggressive.
“I was shocked and scared. My only prayer was not to leave my five-year-old son,” she said.
A growing crisis
Breast cancer is an increasing concern in South Africa, with cases rising steadily over the past two decades.
Research by the National Research Foundation shows that South Africa has a higher breast cancer mortality rate than many comparable countries, largely due to delayed diagnosis and limited access to health care, particularly for black women.
The study found that between 50% and 57% of South African women are diagnosed at a late stage of the disease, with black women disproportionately affected.
Late-stage diagnosis remains one of the country’s most pressing healthcare challenges, prompting renewed calls for investment in early detection.
Barriers to early diagnosis
Thom Renwick, general manager of Roche Products South Africa, said delayed diagnosis is rarely caused by a single issue but rather a combination of systemic barriers.
These include low awareness of early warning signs, the burden of travelling long distances to reach diagnostic facilities, and the cost of transport and time away from work.
“Patients often delay seeking care until symptoms become severe,” he said.
Renwick added that shortages of specialised staff at the primary healthcare level also mean cases are not identified and referred quickly enough.
“In many rural provinces, the ratio of oncologists to the population is critically low. There is also a ‘referral bypass’ phenomenon, where patients skip primary care and go straight to tertiary hospitals such as Chris Hani Baragwanath or Charlotte Maxeke. This leads to overcrowding and long waiting lists,” he said.
Rural healthcare gaps
Significant gaps in breast cancer screening and treatment persist in rural South Africa.
Renwick said many districts lack basic diagnostic infrastructure, such as mammogram facilities, forcing patients to travel long distances for care.
“Combined with transport costs, workforce shortages and delays in referral pathways, this often results in late-stage diagnosis and poorer outcomes compared with urban populations,” he said.
The World Health Organisation has similarly identified limited screening infrastructure and unequal access to cancer services as key barriers to early detection in low- and middle-income countries.
Investing in healthcare systems
Tisha Boatman, executive vice president for global external affairs and healthcare access at Siemens Healthineers, said investing in health care is both a social and economic imperative.
“Stronger healthcare systems improve quality of life, increase productivity and contribute to economic growth,” she said.
“Early diagnosis dramatically improves survival rates. When screening services are brought closer to communities, more women can access care before the disease progresses.”
She added that strengthening clinical capacity within the public healthcare system is just as important as expanding access.
The role of digital health
Healthcare experts say digital tools could play a key role in addressing rising patient volumes and workforce shortages.
“Digitalisation and capacity building allow healthcare professionals to work more efficiently while improving the quality-of-care patients receive,” Boatman said.
Renwick highlighted the potential of artificial intelligence-driven technologies, particularly in rural settings.
“AI-driven point-of-care ultrasound is a game changer. By empowering nurses in rural clinics to triage patients instantly, we can close the diagnostic gap and enable earlier treatment, saving lives that would otherwise be lost,” he said.
Roche noted that advances in pharmaceutical innovation have transformed breast cancer from a potential death sentence into a manageable chronic condition for many patients, but only when diagnosed early.
A personal fight for survival
For Nokwanda, access to timely care came too late in her home province.
Her family eventually took her to Cape Town, where she underwent six months of chemotherapy.
“I don’t know what the future holds, but I am taking it one step at a time,” she said.
*Name changed to protect identity.
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