When the Surgeon Measures, Women Live: The Case for Breast Clinics as an Economic Imperative

Marcia Moyana

It can take up to six months for a woman to receive her pathology results at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Dr Sarah Nietz, the president and lead research surgeon with the Breast Interest Group of South Africa (BIGOSA) says these delays are long enough for a cancer that might have been caught early, contained, treated, to grow into something that steals futures.

And, she believes that these are not just statistics but a crisis needing urgent interventions to prevent the loss of lives.

"Until two weeks ago, the pathology took about six months at Charlotte Maxeke," she told Journal News at the Roche Africa Press Day held in Nairobi, Kenya on 4 March and 5 March.

"We have to be able to measure these system issues in real time so that we can actually start reacting to them in real time."

With this lens, BIGOSA is proactively trying to address the systemic challenges in breast cancer care and treatment for women in South Africa through the establishment of breast centres in different parts of the country.

These centres form part of a clinical intervention that will also advocate for more equitable and accessible breast care services for all women.

A 44% survival rate

South Africa’s overall five-year breast cancer survival rate in the public sector sits at 44%.

In high-income countries, the same figure approaches 90%.

For Nietz, this is not just a comparison between rich and poor, it is between systems that measure outcomes and systems that do not.

Africa carries a disproportionate and worsening cancer burden.

The World Health Organization reports that the continent recorded an estimated 1.1 million new cancer cases in 2022, with breast cancer the leading diagnosis among women. Cervical cancer is largely preventable but remains among the top killers.

Mortality rates are significantly higher than in high-income regions, not because African women are biologically more vulnerable, but because the interval between symptom and treatment is “complex”.

A 2023 study by the German economic think tank Y4 examined what this clinical failure costs in purely financial terms.

Looking at seven African countries, researchers calculated the economic productivity loss from failing to treat HER2-positive breast cancer over a five-year period was $10.3 billion.

A figure that Nietz and BIGOSA found too significantly high to wait for the system to reform itself.

The breast centre model

They are building breast centres and nine founding sites across South Africa that span public and private sectors designed specifically for the country’s context.

The public sector sites include Groote Schuur Hospital at the University of Cape Town (UCT), CMJAH and Chris Hani Baragwanath Academic Hospital.

Six private facilities in Gauteng, Kwa-Zulu Natal and the Western Cape which include Mediclinic Morningside, Lenmed in Lenasia, Life Hilton Private Hospital, Vincent Pallotti Life Hospital and Mediclinic Panorama Private Hospital.

The model is borrowed from European breast centres but is adapted for the South African healthcare sector for better outcomes.

“The whole idea is that we are strengthening each other. And that we are building on the combined strengths and weaknesses. Hopefully this will bring in some dynamics as in terms of resource allocation and in terms of the funding that we are receiving for the project. Roche has been the founding sponsor and this has enabled us to get the central infrastructure,” said Nietz.

The centres are not being designed to concentrate care among those who already have access.

They are designed to generate data, reveal the gaps in the pathway, and pull resources toward the places where patients are currently being lost.

For the centres to offer the best outcomes, clinical surgery, systemic treatment, radiation, pathology, radiology, and a multi-disciplinary team to coordinate all of them will be essential and prioritised.

The Private Sector as a Partner

Tom Renwick, General Manager for Roche Pharmaceuticals in South Africa and Sub-Saharan Africa, said the company has over the years prioritised building health infrastructure as part of its investment in the health sectors where they have a footprint.

"The mindset shift is not looking at healthcare as a cost, but looking at it as the best investment you can make in a population," Renwick said.

Roche has been the founding sponsor of the BIGOSA breast centre initiative, providing the central infrastructure and an international coordinator.

But Renwick’s vision extends beyond a single programme, he sees Roche as a partner in the entire ecosystem of care, from screening through diagnosis to treatment and follow-up.

Dr. Joan-Paula Bor Malenya, Head of the Kenyan National Cancer Control Programme (NCCP) ,offered a parallel model that demonstrates what the private sector can contribute beyond funding.

In Kenya, partnerships with Roche have brought Herceptin which is a targeted breast cancer therapy within reach of women covered by Social Health Insurance Fund (SHIF).

"As I speak into the women-integrated cancer services (WICS), which is integrating care for breast and cervical cancer, non-communicable diseases (NCDs), and mental health, we are getting women to access these services for these conditions combined, integrated in a one-stop-shop model,” said Bor Malenya.

The WICS is meant to reduce costs and travel for women by blending screening services for cervical and breast cancer, NCDs like hypertension and diabetes, and HIV (human immunodeficiency virus) and reproductive health services.

This means that a woman will be screened for all these diseases including testing for the human papillomavirus (HPV) during a single visit at a health facility.

And over 5 000 women have been screened since the project’s inception in 2024. 

The results are already showing according to Bor Malenya.

“We have also realised some health system impact because through this programme, we are able to detect these cancers earlier and that means when we diagnose earlier, the treatment is simpler,” she added.

Her vision is for private partnerships where there are real-time digital dashboards to track patients along the care pathway; point-of-care diagnostics that give results the same day, preventing women from being lost to follow-up and reliable supply chains to reach remote clinics.

Health as a mechanism of development.

Dr. Caroline Mbidyo of AMREF, the largest public health non-profit in Africa reframed the entire debate with a single observation: healthy people are not the beneficiaries of development.

They are the mechanism by which development happens.

"When the IMF projects that by 2035, more young Africans will enter the workforce every year than in the rest of the world combined, that is a possible competitive asset," she told the gathering.

"But it can only be realised if these people entering the workforce are healthy and educated. If they’re not, the largest working population becomes a physical burden to the continent."

According to her, every public investment, roads, telecommunications, agriculture should be evaluated through a health lens.

She explained that two to three pregnant women die every week in Kenya’s West Pokot county trying to reach health facilities.

And why infrastructure like proper roads are not just economic development investments but also critical in ensuring that health services are easily accessible for women from across the continent.

This sentiment is shared by Bor Malenya who called for policymakers to see women’s health as an investment instead of a cost.

“When women are healthy, families are stable, children learn, economies have productivity. Integration is essential for universal health coverage and for our development as a continent," she pleaded.

A strong case

While the conversation in Nairobi was mostly about Kenya and South Africa, the argument it was making belongs to every finance minister and every health planner across the continent.

The economic cost of cancer is one that can no longer be disputed as cases rise and health systems become burdened with competing public health priorities.

Early detection and an equitable access to treatment save money and lives as data shows.

Kenya’s WICS and South Africa’s yet-to-be launched breast clinics are believed to be perfect clinical projects that can be used to lobby for governments to see health budgets as a productive capital expenditure instead of welfare spending.

"We need to use this voice to direct advocacy, to get attention, to inform policy, and to make a difference in the quality of care that we are getting," concluded Nietz.