On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.104 n.5 Cape Town May. 2014
CONTINUING MEDICAL EDUCATION
A SteynI; J du PlessisII; S MeyerIII
IDip DA (Lond), LRAM (Speech and Drama) (Lond). Immediate Past President, Reach to Recovery International, Queensland, Australia
IIChief Executive Officer, People Living with Cancer, Cape Town, South Africa
IIIMSocSc (SW). Cancer Alliance, Cape Town, South Africa
Breast and cervical cancer are leading causes of cancer-related mortality in South African women. Early detection of breast cancer is imperative to improve survival rates. However, public awareness is lacking and healthcare facilities for the diagnosis and treatment of the disease, particularly in the public sector, are inadequate. A cancer alliance, Advocates for Breast Cancer (ABC), was formed in 2014 to campaign for a national breast healthcare policy for South Africa to prioritise the management of this disease.
Breast and cervical cancer are the leading causes of cancer mortality in South African women and in 2000 these cancers accounted for 1.3% of deaths (N=3 157). If breast cancer is detected early, the patient survival rate is >80%. In 2006, the National Cancer Registry (NCR) reported that 1 in 32 South African women will develop breast cancer in their lifetime. These are the latest figures. Of the total number of women diagnosed with breast cancer in 2006 (N=5 869), 3 832 4 (65%) visited private healthcare facilities, which can be attributed to better access to diagnostic resources in this sector. It is widely accepted that there is significant under-reporting of breast cancer in the public sector.
Many factors contribute negatively to the diagnosis of cancer. Examples include the stigma attached to this disease in rural communities, little or no awareness of cancer in general, and comorbidities, e.g. HIV/AIDS, poverty, lack of equitable services, inability of health professionals to diagnose cancer at an early stage and referral pathways that do not allow for easy access to services.
There is currently no breast healthcare policy in South Africa. In the 2013 - 2019 non-communicable diseases (NCD) Strategic Plan for South Africa, treatment of stage 1 breast cancer is listed as one the most cost-effective interventions, as the financial cost is low.
At the 17th Reach to Recovery International Breast Cancer Support Conference held in Cape Town, South Africa in March 2013, a meeting was held with the Deputy Minister of Health to advocate and lobby for a breast health policy. For this meeting the Breast Health Global Initiative's summary tables, from their Guidelines for International Breast Health and Cancer Control Implementation, were provided as an example of what South Africa can consider as a standardised breast health policy. This document covers all aspects of the cancer continuum and discusses services for basic, limited, enhanced and maximal settings. A firm commitment was made that such a policy would be developed nationally.
One year later, South African breast cancer non-profit organisations have come together as one voice under the banner of the Cancer Alliance to form the Advocates for Breast Cancer (ABC), the purpose being to campaign for a national breast health policy for South Africa. The ABC will develop a three-pronged approach that will include the following:
Advocating and lobbying with regard to skills training for breast cancer organisations to build the skills capacity of women.
An extensive communication strategy that will focus on the main issues around breast health to ensure that the voice of women in all communities is heard.
Building partnerships with the National Department of Health and other departments that focus on women and education to ensure policy development and implementation.
Organisations that came together for this historic event were:
Reach to Recovery
Breast Health Foundation
People Living with Cancer (PLWC, incorporating Cancervive)
Journey of Hope
Breast Course for Nurses.
ABC believes that to significantly change breast cancer services for the majority of women in this country, management of this disease must be prioritised by national government. Involved organisations must combine their efforts with healthcare professionals to make it a matter of prime importance.
2. National Institute of Occupational Health (NIOH). Summary statistics of cancer diagnosed histologically in 2006. All females. http://www.nioh.ac.za/assets/files/NCR_2006_TABLES_FINAL.pdf (accessed 7 March 2014). [ Links ]
3. Department of Health. Strategic Plan for the Prevention and Control and Non-Communicable Diseases 2013 - 2017. Pretoria: Department of Health, 2013. [ Links ]
4. Anderson BO, Yip CH, Smith RA, et al. Guideline implementation for breast healthcare in low-income and middle-income countries: Overview of the Breast Health Global Initiative Global Summit 2007. Cancer 2008;113(S8):221-224. [http://dx.doi.org/10.1002/cncr.23844] [ Links ]