Breast cancer is killing African women too young — and the system is failing them
Dr. Tonia Frame, Assistant Professor and Director of the Global Health Unit at SGU.
New global data exposes a continent-wide crisis in early detection, as experts call for risk-based screening and greater investment in diagnostic infrastructure
By Tonia Frame
Breast cancer is the most diagnosed cancer among women across Africa and the leading cause of cancer-related deaths on the continent, yet the systems needed to detect and treat it remain dangerously inadequate for millions of women. New estimates published in 2026 by the International Agency for Research on Cancer reveal that Africa recorded approximately 225,643 new breast cancer cases and around 100,070 deaths in 2024 alone — figures that experts say reflect not just the scale of the disease but the depth of a healthcare crisis that demands urgent attention.
The statistics carry a particular urgency when considered alongside the age at which African women are being diagnosed. A 2025 study spanning five sub-Saharan African countries found that nearly one in five women diagnosed with breast cancer — 21.9 per cent — was under the age of 40. That finding challenges assumptions about who is most at risk and raises serious questions about screening programmes designed around age thresholds that may not reflect African realities.
St. George’s University public health expert Dr. Tonia Frame, who serves as Assistant Professor and Director of the Global Health Unit in the Department of Public Health and Preventive Medicine, argues that age alone is an insufficient guide to screening decisions. “Breast cancer risk does not suddenly begin at a particular birthday, and two women of the same age may have very different risk profiles,” she said. “Women should be encouraged to become familiar with the usual appearance and feel of their breasts and to seek prompt clinical evaluation for unexplained breast changes.”
Frame added that in Africa, where breast cancer often presents at a comparatively younger age and access to high-quality imaging is uneven, discussions about early detection must extend well beyond age-based thresholds. Family history, inherited susceptibility, previous breast findings and other recognised risk factors, she said, can all help determine whether a woman may benefit from earlier assessment, specialist referral or additional imaging.
The case for a risk-informed approach is compelling. Women with a family history of breast or ovarian cancer — particularly where diagnoses occurred at younger ages, where cancer affected both breasts, or where multiple relatives were affected — may warrant earlier assessment before the age of 40. Those carrying BRCA1 or BRCA2 gene variants may require screening beginning as early as 25. Women with dense breast tissue, which can reduce the effectiveness of mammography and is independently associated with higher risk, may need supplemental imaging such as an MRI. Women with previous high-risk breast lesions or abnormal biopsy results should be managed through an individualised plan developed in consultation with their physician.
The challenge, however, is that millions of African women have no meaningful access to any of these options. A 2026 systematic review and meta-analysis found that only 13 per cent of women in sub-Saharan Africa had ever undergone a clinical breast examination, with uptake shaped by education levels, household wealth, health insurance coverage and contact with healthcare services. The World Health Organisation’s Regional Office for Africa has identified significant gaps in diagnostic infrastructure and critical shortages of specialist healthcare personnel as key drivers of late diagnosis and poor survival outcomes.
Closing those gaps requires sustained, structural investment. Experts point to several immediate priorities: strengthening clinical breast examination and referral pathways; training frontline health workers to identify and respond to concerning symptoms; expanding access to diagnostic imaging and pathology services; ensuring timely follow-up after abnormal findings; and monitoring outcomes across socioeconomic and geographic groups to identify where the system is failing most acutely.
Artificial intelligence is also being evaluated as a potential tool to support early detection in settings where imaging capacity and specialist availability are limited. Depending on the technology and clinical context, AI systems may assist with triage, image interpretation, workflow prioritisation or risk estimation. Frame urges caution, however, about treating technology as a solution in isolation. “Integrating community health workers, portable AI technology and digital referral pathways within primary health care could potentially help reach women who face geographic, financial or health-system barriers,” she said. “The most important feature is not the algorithm alone, but the complete pathway linking awareness, initial assessment, referral, diagnostic confirmation and treatment. AI output is not a diagnosis.”
For individual women navigating an unequal system, Frame and her colleagues advocate a shared decision-making approach in which patients are encouraged to ask their physicians direct questions: when should screening begin given their personal risk factors; whether their family history warrants formal risk assessment; whether genetic counselling is appropriate; how breast density affects the interpretation of their mammogram; and which services are locally available should an abnormality be found. A more personalised approach, Frame emphasises, does not mean more tests for every woman. It means ensuring that those most likely to benefit from earlier or more intensive screening are identified, while avoiding unnecessary procedures for those who are not.
Breast Cancer Awareness Month serves as an annual reminder of how much remains undone. Across Africa, the most urgent task is not simply raising awareness but ensuring that every woman with a concerning symptom or abnormal finding receives timely assessment, accurate diagnosis and appropriate treatment — without the delays that are currently costing lives.
The data is unambiguous. The knowledge exists. What Africa needs now is the political will, the investment and the infrastructure to act on both.
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