She is 37 years old, a mother of three, and the only breadwinner in her household. She noticed the lump in her breast almost a year ago, but the clinic is far, the queues are long, and there were school fees to pay and children to feed. By the time she reaches our hospital in Durban, the cancer has already spread to her bones and liver.
Her options have narrowed, and so have her chances. Behind her stand three children, an elderly mother, and an extended family whose livelihoods depended on her income. As a nuclear medicine physician, I frequently encounter her -or someone very much like her.
Her story is not an exception.
In African women, aggressive breast cancers commonly occur even under the age of 40. In the largest breast cancer study conducted across sub-Saharan Africa, more than one in five women were diagnosed before 40, and it was these young women, particularly recent mothers, who had the poorest survival.
If these deaths were caused by a person rather than a disease, we would call it what it is: the work of a serial killer. Breast and cervical cancer are the two leading cancer killers of South African women, and together they claim more than 10 000 women every single year, with ovarian cancer (the so-called silent killer) and cancer of the womb following closely.
Globally, cancer claims about 2.3 million women prematurely every year, and researchers estimate that nearly seven in ten of these deaths could have been prevented or treated in time. The cruellest part of this arithmetic is where the dying happens. Women in the world’s poorest countries are the least likely to develop cancer, yet they are the most likely to die from it.
Nineteen of the twenty countries with the highest cervical cancer burden on earth are in Africa, and roughly 90% of cervical cancer deaths occur where access to prevention, screening and treatment is poor. This is criminal for a cancer we can vaccinate against, screen for and, once detected, cure early.
Across sub-Saharan Africa, more than 70% of women with breast cancer are diagnosed at an advanced stage, typically after delays of more than three months -compared with fewer than one in five women in Europe or the United States. Ovarian cancer is quieter still, with about 80% of cases only discovered at an advanced stage when the options have already narrowed.
The consequence is devastating: half of the women diagnosed with breast cancer in sub-Saharan Africa die within three years of a disease that more than nine in ten women survive when detected early in well-resourced settings.
Researchers estimate that at least a third of the 416 000 breast cancer deaths projected for sub-Saharan Africa over the coming decade could be prevented through earlier diagnosis and better access to treatment. These women do not die because their cancers are untreatable. They die because their cancers are found too late.
And when they die, whole families unravel. More than four in ten South African households are headed by women. The woman who dies of a late-diagnosed cancer is very often the one earning the income, raising the children, and caring for the elders. In 2020 alone, an estimated one million children worldwide lost their mothers to premature cancer deaths.
Harriet Beecher Stowe wrote that “women are the real architects of society”. Every time we lose an architect mid-build, the whole structure is weakened for households, communities and the economy alike. This is where my speciality, nuclear medicine, comes in and why I believe it belongs at the heart of women’s cancer care in Africa. Our approach can be summed up in three words: find, fight and follow up.
A single whole-body PET/CT scan (positron emission tomography) uses a tiny amount of a radioactive tracer to find cancer wherever it hides, showing us the biology and behaviour of the disease in addition to its structure. International guidelines recommend PET/CT for staging locally advanced cervical cancer, where it changes the management plan in roughly four out of ten cases.
Accurate staging from the outset means the right treatment from the outset: sparing one woman a major operation that cannot cure her, and offering another the curative treatment she would otherwise have been denied.
In demonstrating the metabolism of a tumour, PET/CT scans can reveal within one or two cycles whether chemotherapy is actually working - long before a lump visibly shrinks or grows. That allows us to change management timeously, sparing women months of side effects from treatment that carries no benefit, and sparing the health system the cost of it.
Through theranostics, which is one of the fastest-growing fields in cancer medicine, the same molecular target we use to see a cancer can be used to treat it, delivering radiation directly to tumour cells with remarkably few side effects. Yet nuclear medicine is still too often dismissed as a luxury for wealthy countries. Economics says the opposite.
A landmark Lancet Oncology Commission calculated that scaling up medical imaging alone would save about 2.5 million lives worldwide this decade and almost 10 million when combined with treatment. This translates to the return of more than twelve dollars for every dollar invested, with a net economic benefit to the world of around 2.66 trillion dollars.
Meanwhile, Africa has fewer than 200 PET/CT scanners concentrated in just 12 countries; not a single African country has even one scanner per million people, and 20 African countries have no nuclear medicine service at all. Even the specialised workforce is skewed, with around 70% of the continent’s qualified radiopharmacists working in just two countries - Egypt and South Africa.
The truth is that the most expensive scan is the one that is never done: operating on disease that has already spread, or giving month after month of futile chemotherapy, costs far more- in money and in lives than diagnosing precisely from the start. It is diagnostic imprecision, not technology, that resource-constrained health systems cannot afford.
Wherever there is a radiology or oncology service, there must be nuclear medicine, so that precision diagnosis and personalised, targeted treatment becomes standard -never an optional extra. So this Women’s Month, beyond the celebrations and the speeches, I would like to ask three things of us all. Let us encourage the women in our lives to take any new change seriously and to seek help early, because a breast lump does not disappear simply because we are too busy or too afraid to have it examined.
Through cervical screening and HPV vaccination, we could potentially eliminate cancer within a generation. Let us insist that every woman diagnosed with cancer receives prompt and accurate staging with the best tools we have, so that the right treatment is chosen from the very beginning rather than found through trial and error. And let us build by investing deliberately in nuclear medicine facilities and training across South Africa and our continent, until the place where a woman lives no longer decides whether her cancer is found in time.
We cannot bring back the women we have already lost. But we can decide, starting now, how many more we are willing to lose. As the saying goes: a society which does not protect, respect and honour its women can have no claim of being civilised. This August, let us prove our claim.
* Professor Mariza Vorster is the Head of the Department of Nuclear Medicine at the University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital in Durban, and the immediate past President of the College of Nuclear Physicians of South Africa (CMSA).
**The views expressed do not necessarily reflect the views of the National Media Group.