Fatal flaws: ‘Cancer is the new HIV crisis’
Lengthy referral systems and inadequate screening programmes are making a dire situation worse, say experts
When Nathi Molefe’s breast cancer went into remission after chemotherapy four years ago, she thought her difficulties with the public health sector were over.
But in June the 38-year-old mother found herself back at square one when the cancer returned, this time in her lungs and chest.
When she went to Inkosi Albert Luthuli Central Hospital in Durban, where she works as a volunteer for the Breast Cancer Foundation, she was told to come back in October for more tests.
“I couldn’t wait for so long because I know that cancer spreads quickly. As a cancer educator I knew that the longer I wait the more difficult treatment will be. So I moved to Gauteng, where I received treatment immediately,” she said.
In September Molefe hit another snag when the Charlotte Maxeke Johannesburg Academic Hospital told her chemotherapy would be suspended until further notice because it had run out of the drug she was on, Taxol.
Despite not having had treatment for a few weeks, Molefe still considers herself lucky compared with other SA women who wait for months before being diagnosed, let alone treated.
“Because I work in a hospital environment I got diagnosed immediately, unlike many women who have to go to clinics multiple times before they are finally referred to cancer centres,” she said.
“Should I have taken the route of first going to the clinic it would probably have taken another year before I got diagnosed.”
Last week, Molefe resumed chemotherapy in the private sector after the Breast Cancer Foundation intervened.
Her experience is far from unusual, according to Professor Jennifer Moodley of the Cancer Research Initiative at the University of Cape Town.
Not only were South Africans illiterate when it came to cancer symptoms, often arriving at health facilities with advanced tumours that were difficult to treat, but lengthy referral systems and inadequate screening programmes exacerbated the situation.
For example, while a cervical screening programme had been launched in 2001, it still covered only 57% of the population.
Writing in the SA Medical Journal, Moodley said a substantial proportion of advanced breast cancer cases could be avoided if patients presented within one month of detecting symptoms.
According to the National Cancer Registry, a division of the National Health Laboratory Service, one woman in 29 will develop breast cancer, with about 7,000 new cases annually.
Breast cancer is the most common form of the disease among women, while cervical cancer is the most deadly. About 46% of breast cancers in SA are diagnosed at advanced stage.
Salomé Meyer, project manager at Advocates for Breast Cancer, said apart from not being well informed about breast cancer symptoms, many women did not attend clinics for check-ups. This was owing to the stigma of cancer and the cost of transport.
“Many fear for what will happen to them ... that their husbands will leave them, and that they are cursed. Many times when women are diagnosed they are the breadwinners, and for them it means that their families will go without food whilst they are being treated,” said Meyer.
But all is not lost. The Health Department’s new breast cancer policy introduces clinical guidelines for the treatment of cancer and pledges to establish 14 specialised breast cancer units at tertiary hospitals.
Louise Turner, head of the Breast Cancer Foundation, described cancer as the new HIV crisis.
“It took years for the government to realise there was a problem. It has successfully been dealt with after civil society advocacy pressured government to acknowledge and do something about HIV,” she said.
“Cancer is only now becoming a common household name.”