Attempts under way to fix gap in SA's plan to fight cancer
Experts say cancer patients in the public sector in South Africa are dying for avoidable reasons like dysfunctional referral systems and a lack of medical imaging and treatment. We look at efforts to get the country's battle with cancer back on track.
Many people with cancer in Gauteng have not been able to access the treatment and care they require in recent years. Though activists and the provincial government are at odds about what should, or should have been, done about it, nobody is denying that there is a problem.
At the same time, there has also been issues at a national level, with South Africa's key cancer strategy having lapsed. The National Cancer Strategic Framework for South Africa 2017—2022 was previously extended to also cover 2023. Medical Brief recently reported that a new strategy is on the verge of being signed by the director-general of health.
The committee meant to advise the minister on cancer has also lapsed. Dr Busisiwe Ndlovu, the top government official in charge of non-communicable diseases (NCDs), said that the term of the Ministerial Advisory Committee on Cancer expired in early 2024, and new members were pending the approval of health minister Dr Aaron Motsoaledi. She was speaking at the KwaZulu-Natal leg of a cancer research and innovation strategy workshop in May. These consultative meetings are taking place across the country's provinces. It aims to shape a national research and innovation strategy based on the World Health Organization's cancer-control pillars:
prevention;
early detection and diagnosis;
treatment; and
palliative care and survivorship.
The scale of the problem
While researchers anticipate that rates of infectious diseases like HIV and tuberculosis in South Africa will decline in the coming decade or two, rates of NCDs, including diabetes and cancers, are expected to increase. According to the WHO, an estimated one in five people will develop some form of cancer in their lifetimes. Increases in developing countries are expected to be particularly steep.
According to a Stats SA report published in 2023, and based on National Cancer registry (NCR) numbers and Stats SA's mortality data, cancer-related deaths in the country increased by 29% from 2008 to 2018. They reported that 85,000 people were diagnosed with cancer in 2019 and that 44,000 died of cancers in 2018. Experts previously told Spotlight that the estimate of cancer cases may be an undercount of as much as 40%.
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Daily Maverick
6 hours ago
- Daily Maverick
Attempts under way to fix gap in SA's plan to fight cancer
Experts say cancer patients in the public sector in South Africa are dying for avoidable reasons, such as dysfunctional referral systems and a lack of medical imaging and treatment. Spotlight looks at efforts to get the country's battle with cancer back on track. Many people with cancer in Gauteng have been unable to access the treatment and care they require in recent years. Though activists and the provincial government are at odds about what should, or should have been, done about it, nobody denies that there is a problem. At the same time, there have also been issues at a national level, with South Africa's key cancer strategy having lapsed. The National Cancer Strategic Framework for South Africa 2017-2022 was previously extended to also cover 2023. Medical Brief recently reported that a new strategy is on the verge of being signed by the Director-General of Health. The committee meant to advise the minister on cancer has also lapsed. Dr Busisiwe Ndlovu, the top government official in charge of non-communicable diseases (NCDs), said that the term of the Ministerial Advisory Committee on Cancer expired in early 2024, and new members were pending the approval of Health Minister Dr Aaron Motsoaledi. Ndlovu was speaking at the KwaZulu-Natal leg of a cancer research and innovation strategy workshop in May. These consultative meetings are taking place across the country's provinces. It aims to shape a national research and innovation strategy based on the World Health Organization's cancer control pillars: prevention, early detection and diagnosis, treatment, and palliative care and survivorship. The scale of the problem While researchers anticipate that rates of infectious diseases such as HIV and tuberculosis in South Africa will decline in the coming decade or two, rates of NCDs, including diabetes and cancers, are expected to increase. According to the WHO, an estimated one in five people will develop some form of cancer in their lifetimes. Increases in developing countries are expected to be particularly steep. According to a StatsSA report published in 2023, and based on National Cancer registry (NCR) numbers and StatsSA's mortality data, cancer-related deaths in the country increased by 29% from 2008 to 2018. They reported that 85,000 people were diagnosed with cancer in 2019 and that 44,000 died of cancers in 2018. Experts previously told Spotlight that the estimate of cancer cases may be an undercount of as much as 40%. The most common cancers in men were prostate, colorectal and lung – around one in four cancer diagnoses in men were for prostate cancer. Bronchus and lung cancer accounted for just under 19% of cancer-related deaths in men, while prostate cancer accounted for around 17%. Among women, the most diagnosed cancers were breast cancer at around 23% of diagnoses and cervical cancer at around 16% of diagnoses. Cervical cancer accounted for just under 18% of all cancer deaths in women and breast cancer for 17%. The NCR recorded 87,853 new laboratory-confirmed cancer cases in 2023, although this figure probably underestimated the true burden as it excluded clinically or radiologically diagnosed cancers, Dr Judith Mwansa-Kambafwile, senior epidemiologist with the NCR, told attendees at the Durban workshop. In a paper published in the South African Journal of Oncology in 2022, researchers calculate that cancer incidence (new cases per year) in South Africa could double from around 62,000 in 2019 to 121,000 in 2030. This is due to two factors: first, South Africa's population is ageing and cancers generally become more common as people age. And second, the risk of cancers is generally increasing for people of all ages. The researchers focused on only the five most common types of cancer, but an NCR report shows a very wide variety of cancers are being diagnosed in the country. Since not all cancers are diagnosed, the real numbers are probably substantially higher than reported. There is also no single repository of all cancer diagnoses in the country – for the above-quoted article, researchers used both data from Discovery Health Medical Scheme and the NCR. The data gap Cancer statistics in South Africa have been largely based on pathology results, which is to say blood or biopsies that were tested in the lab. Other types of diagnoses, such as those based on symptoms and scans, have not always been counted systematically. One recent initiative aimed at addressing this data gap is a patient-led registry that feeds information into the NCR. Mwansa-Kambafwile explained that the NGO, Living with Cancer, was driving the patient-led registry, aimed at cross-referencing and supplementing patient records with her NCR's patient database. Leaflets in oncologists' reception rooms encouraged patients to upload their pathology/histology test results on to the Living with Cancer website via a standard online National Department of Health form. A national shopping mall campaign in May was aimed at boosting awareness. 'Living with Cancer had a Memorandum of Understanding with us and in addition, links cancer survivors with the same type of cancer to one another in support groups online where they can share experiences and knowledge,' she said. Dr Mazvita Muchengeti, who heads work on the NCR at the National Health Laboratory Services, which is part of the National Institute for Communicable Diseases (NICD), previously told Spotlight that cancer was made a reportable disease under the National Health Act in 2011. While compulsory reporting has improved data on cancer cases, she said, 'There is an increase in the number of reported cancers; this does not necessarily translate to an increase in cancer, we are just counting cancer cases better because reporting is now compulsory.' Another new strategy In light of the country's cancer burden, a group of organisations is leading the development of a new National Cancer Research and Innovation Strategy. This collective includes the Nuclear Medicine Research Infrastructure at the University of Pretoria, the South African Medical Research Council, and the Department of Science, Technology and Innovation, in partnership with the National Department of Health. They are hosting provincial workshops to help understand the state of cancer research in South Africa, identify key challenges, set national priorities and develop a strong, future-focused strategy. These workshops are part of a broader plan to make sure the strategy is inclusive, based on evidence, and meets the country's needs. This research and innovation strategy differs from the health department's National Cancer Strategic Framework, which guides provinces on what the cancer priorities are. 'Integrated cancer care approach' At the Durban workshop, Ndlovu emphasised the need for an integrated cancer care approach across all levels of the healthcare system. She noted the importance of streamlined referral pathways and urgent attention to waiting times, care packages, registry improvements and financing. The expired national cancer strategy required urgent evaluation and revision, Ndlovu said. A clear pattern emerging from these workshops is one whereby cancers are often diagnosed too late, and patients frequently struggle to access timely, appropriate care. Also at the Durban workshop, Professor Jeannette Parkes, Head of Radiation Oncology at Groote Schuur Hospital and the University of Cape Town, outlined the many systemic barriers to early detection. These included sociocultural factors, urban-rural divides and broken referral systems. 'We have a massive issue with accessing imaging services, biopsy support, pathology services and their costs,' she said. Parkes, who is also President of the College of Radiation Oncology of South Africa and clinical director of the Access to Care Cape Town programme, said early cancer detection was better in the private sector because patients could access and afford the necessary systems and diagnostic technology. The remaining 85% of the population depended on the public sector, in particular overburdened primary healthcare clinics, but also on all levels of care. 'There's a bias towards urban versus rural areas and too often a failure to refer. The referral pathway is problematic and differs from province to province and in various settings. We have a massive issue with regard to accessing imaging services, while biopsy support and pathology services and their costs are also a big issue,' she told the workshop. Late diagnosis At the Johannesburg meeting, late diagnosis was singled out as a particular problem when it came to cervical cancer. Dr Mary Kawonga, public health specialist with the Gauteng Department of Health and Wits School of Public Health, said that 16% of women screened at Charlotte Maxeke Academic Hospital's drainage district had pre-cancerous lesions, underlining the lack of preventative care. 'Patients often only begin treatment on their sixth visit,' she said, citing the failure of diagnostic tools, referral inefficiencies and poor implementation of available technologies. Dr Mariza Vorster, head of Nuclear Medicine at the University of KwaZulu-Natal and Inkosi Albert Luthuli Academic Hospital, said that insufficient specialists and excessive patient loads resulted in unacceptable turnaround times for diagnosis. Clinicians often get blamed for delays, but as Dr Sheynaz Bassa, head of Radiation Oncology at Steve Biko Academic Hospital, pointed out, many patients waited weeks or months to afford transport to care facilities. 'By the time they get to us, they're already in crisis mode,' she said. 'Peripheral clinics and hospitals must improve referral systems before we can make real progress.' Salomé Meyer, director of Cancer Alliance, alleged that survivorship care was almost entirely absent in both the public and private sectors. 'Supportive and palliative care often ends when treatment stops. Survivors are left without coordinated care,' she said. Apart from improving screening and referral systems, other recommendations emerging from the workshops included better coordination between clinicians and the NCR, leveraging mobile technology such as the health department's Mom Connect app to reduce clinic visits and fast-track referrals. Greater community involvement in setting research priorities, using mobile clinics to conduct cancer screening in rural areas, and increasing awareness of breast self-examination. More research into the genetic factors relating to cancers in South Africa was also argued for. Call for new cancer institute Meyer has been leading a call for South Africa to establish a National Cancer Institute (NCI). 'An NCI would develop clear guidelines on treatment protocols, workforce allocation and facility requirements,' she said. With South Africa transitioning toward a National Health Insurance system, Meyer said an NCI would help plan resource allocation based on cancer projections, enabling smarter investments in infrastructure, technology and staffing. The lapsed National Cancer Strategic Framework lacked province-specific detail, leaving provinces to adapt guidelines as they saw fit, often leading to fragmented service delivery, Meyer said. She said decentralisation was essential. 'We can no longer restrict cancer treatment to tertiary hospitals. Many district and regional facilities could provide diagnostics and some treatments if properly resourced,' she said. A reset of South Africa's disease monitoring and research infrastructure has been on the cards for some time. The NICD was set to be replaced by the new National Public Health Institute of South Africa (Naphisa) after the Naphisa Act became law in 2020. Five years later, Naphisa has not yet been established. On the face of it, Naphisa would be a natural home for an entity like the proposed NCI were it to be created. DM
The Citizen
11 hours ago
- The Citizen
Limpopo Health launches male circumcision drive to fight HIV
LIMPOPO – The Limpopo Department of Health is urging males aged 10 and older to participate in its voluntary male circumcision campaign, launched as part of a province-wide effort to reduce the risk of HIV transmission and promote better overall male health. Limpopo Health MEC Dieketseng Mashego officially launched the campaign on Friday, June 20, at the Evelyn Lekganyane Clinic in Boyne, just outside Polokwane. The campaign will be rolled out across the province, with various hospitals and clinics offering free circumcision services. Hospitals such as Letaba and Van Velden are now accepting bookings through their respective clinics and health centres. These include the Dan Clinic, Nkowankowa Health Centre, Letaba Gateway Clinic, Letsitele Clinic, and Ooghoek Clinic, among others. Letaba Hospital will officially launch its leg of the campaign on June 30 at the Nkowankowa Health Centre. Circumcisions at the hospital will continue to be available throughout the year. For more information or to book a procedure, contact the acting communication officer at Letaba Hospital, Inno Mokgolobotho, at 015 303 8210. At Caxton, we employ humans to generate daily fresh news, not AI intervention. Happy reading!
The Citizen
2 days ago
- The Citizen
Fact-checked: HIV/Aids breakthrough not a ‘cure', popular social media posts misrepresent the facts
While promising, a recent breakthrough in HIV research is not a 'cure' or a 'vaccine', as several posts claim on social media. The scientists involved say it could be many years before the technology is used as a cure. Users on Facebook, Instagram and X have shared the same 'BREAKING NEWS' message, claiming that 'A CURE FOR HIV/AIDS HAS JUST BEEN FOUND'. Africa Check found hundreds of these posts, the most popular of which have been viewed millions of times. The message is typically accompanied by a graphic which includes the text 'Researchers in Australia have just found a cure for HIV/Aids' and an image created using artificial intelligence tools, of a bottle labelled 'HIV Vaccine®'. Unfortunately, this claim is not true. The human immunodeficiency virus, or HIV, is a virus which attacks the immune system, the processes responsible for protecting the body from disease. If left untreated, it causes acquired immunodeficiency syndrome, or Aids. HIV can be treated with antiretroviral drugs, which prevent the virus from multiplying in a person's body. ARV treatment can lower the level of the virus in a person's body to the point that it is undetectable and cannot be transmitted to others. However, ARVs cannot eradicate the virus entirely. So what has prompted these 'breaking news' posts? In this case, there is a real scientific breakthrough behind these claims, but it has been described in a misleading way. Deliberately misleading headline and image shared alongside text copied from genuine news story These posts include paragraphs of text, describing the scientific breakthrough. They begin: A cure for HIV could be a step closer after researchers found a new way to force the virus out of hiding inside human cells. The virus's ability to conceal itself inside certain white blood cells has been one of the main challenges for scientists looking for a cure. It means there is a reservoir of the HIV in the body, capable of reactivation, that neither the immune system nor drugs can tackle. Now researchers from the Peter Doherty Institute for Infection and Immunity in Melbourne, have demonstrated a way to make the virus visible, paving the way to fully clear it from the body. The text is identical to the first 12 paragraphs of a news article published by the UK's Guardian newspaper on 5 June 2025. None of the posts which Africa Check found clearly credited the Guardian as the source, nor did they include the entire article. The original article is headlined: 'Breakthrough in search for HIV cure leaves researchers 'overwhelmed'.' In the posts on social media this has been replaced, usually with a variation on 'Breaking News: A cure for HIV/Aids has just been found', sometimes misspelling Aids as 'Auds'. The Guardian article never refers to the research as a 'cure', but only as a promising step towards one. In sections of the article not included in the social media posts, researchers are quoted as being 'very hopeful' that the breakthrough could eventually be replicated in humans. But this could be a long way off. The Guardian notes: 'The path to using the technology as part of a cure for patients is long and would require successful tests in animals followed by safety trials in humans, likely to take years, before efficacy trials could even begin.' The Guardian links back to the original scientific paper, published in the journal Nature Communications. The paper also does not refer to its findings as a 'cure' for HIV. Although they don't represent a 'cure', the findings are a promising development in HIV research. Promising advancement in research, not HIV cure As already discussed, ARV medications can reduce the presence of HIV in a person's body, but not eradicate the virus entirely. The Nature Communications article covers research into a potential solution to this problem. In their paper and in comments to the Guardian, the University of Melbourne researchers describe a new method of delivering genetic material, known as mRNA, into certain kinds of white blood cells. HIV is able to infect these white blood cells, where it can essentially hide from the body's immune system and other forms of treatment. Being able to reach the virus inside those white blood cells opens up new opportunities to treat it. Vaccines against Covid-19 also made use of mRNA, which may be why the graphic accompanying these 'HIV cure' claims depicts an 'HIV vaccine'. (The image in the graphic is very similar to stock images that have existed since 2016.) The Nature Communications study did not use mRNA to vaccinate against HIV, but demonstrated that 'therapeutic mRNA', such as small pieces of mRNA designed to alert the immune system to the presence of the virus, could be delivered to these white blood cells. At time of writing, there is no cure for HIV/Aids. But besides this breakthrough, there have been other promising developments in HIV treatment. Real breakthroughs in HIV treatment In 2023, a clinical trial began in South Africa and the US to test the efficacy of a potential vaccine against HIV called VIR-1388. Like other vaccines, VIR-1388 would not be a cure for HIV but, if it works, may prevent infection and therefore stop the spread of the disease. It was developed by US-based Vir Biotechnology. ARVs can be taken as pre-exposure prophylaxis, or PrEP, by people who are HIV negative but likely to be exposed to the virus. This can prevent transmission of HIV. However, PrEP must be taken frequently to ensure proper protection. Current South African PrEP guidelines involve taking one pill every day. Lenacapavir is an injectable drug which has been shown to reliably protect against HIV transmission for six months at a time, with some trials demonstrating protection for a full year. After successful trials, there are plans to begin use of the drug in countries such as South Africa, which has a particularly high burden of HIV. It has been approved for use in the US. Like other forms of PrEP, Lenacapavir is neither a 'cure' nor a 'vaccine', but can prevent HIV transmission. Because it is much longer lasting than other forms of PrEP, it may make it much easier to prevent transmission.
