Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
I’ve just been diagnosed with breast cancer- help!
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Managing breast cancer in a government hospital  
This series of blogs was originally written by me for the Advocates in Breast Cancer website.

Check out their website at

I haven’t got a medical aid- what do I do?
What if I can’t get good treatment?
Why do people delay treatment?
I haven’t got a medical aid- what do I do?
Being told that you have cancer is one of the most stressful life experiences. As well as the immediate worries about your health and your family, work and financial worries can overwhelm you. More than 80% of patients do not have a medical aid, but even more women may have let their medical aid run out, or discover they are not covered in a way that they thought they were. Does this mean that you won’t get good care?

The answer to this is an unequivocal NO!

Despite what you may think, there are many excellent government cancer facilities throughout the country. It may mean you have to travel further from your home, but there are also many organisations that wish to help patients who do not have the resources for travelling to a hospital or manage treatments.

In breast cancer, specialists strive to make sure all patients have access to exactly the same standard of care that is available in private. That means diagnosis quickly and reliably, access to the correct medications, the same support groups, the same research trials. Some times this is not possible because of cost- this is the case with drugs for HER2 positive breast cancer, but it should not be the case for surgery, reconstruction, chemotherapy or radiation.

There are two big differences between government and private services: The first is that if you head to a specialist breast clinic, available in all our major cities, you will be getting the most up to date care but specialists who are experts in their field. This may be even better than many of the private hospitals with less specialist services, and will be available at a tiny fraction of the cost or even free.

The second difference is that it there may be more inconvenience. You may have to wait in a clinic to be seen, you may have to be careful to keep a copy of your results safe in case they get lost, or you may have your operation delayed due to problems in service. However it is rare that these delays will be longer than international guidelines: for instance in the UK the standard is two weeks for an appointment to see a specialist, at our Helen Joseph Breast Care Clinic in Johannesburg we see any patient, from anywhere in Africa, in an open access clinic every Tuesday, so you can be seen the same week you notice a problem.

There are a number of specialist breast units in South Africa in state and private that treat patients and manage breast cancer without leaving you debt or difficulty. The Breast Health Foundation helpline (0860 buddie) is one way to get advice on how to find the nearest specialist breast unit.
What if I can’t get good treatment?
Many women are worried about the government health system in South Africa, and when they do not have medical aid for any reason they ask: should you come to a private facility at huge costs instead of receiving treatment at a state facility at a fraction of the cost? The answer is that sometimes the only possible difference between state and private facilities is convenience. In a public hospital, due to resource constraints on staff and facilities a patient might have to wait longer for a treatment then in public- but in most specialist breast care centres in South Africa this should never be longer than international guidelines.

At other times though, a breakdown in equipment or services means that your treatment is delayed. If it happens that your operation or treatment is delayed remember these tips:
  • The hospital staff are ON YOUR SIDE. They want to see you treated well and if they show impatience it is because they are frustrated that they can’t care for you. both sides need to remember courtesy!
  • Pester-power is your friend. The CEO of the hospital may not be aware of the problem. Contact him by email or attend his office for an appointment. Keep copies of your letters and copy emails to your councillor, newspaper and local government representative.
  • Don’t give up. Large hospitals can be frightening and make you feel vulnerable. Bring a friend or family member with you who can speak up for you.
  • (This is a secret you need to know!) An ethical medical professional will NEVER compromise your care because you have made a fuss, in fact you may find they speed up your care to get you out of there! So don’t be afraid to speak up.
There is also a strong connection between many public breast units and support groups. These groups and councillors such as the Breast Health Foundation of South Africa (Helpline 0860 buddie), can guide and support you, act as your advocate, and make sure you don’t ‘fall through the gaps’ of cancer treatment.
Why do people delay treatment?
Breast cancer is one of the two leading causes of death from cancer in women in South Africa. In high-income countries, 2 in 7 women diagnosed will die of breast cancer. In lower-income countries including South Africa, this figure is 3-4 in 7 or even higher.

The best treatment and cure for breast cancer depends on two things: early diagnosis and excellence in care. In South Africa, government and private patients alike have access to nearly all available treatments to beat breast cancer, but still more patients will die: this is because they delay coming to get care.

Delay can happen in a number of ways for a number of reasons but all are important. A delay of more than three months is associated with more advanced cancers and with an increased chance of death.

After any women notices a problem with her breast she needs to see a healthcare worker. There may be delay here because you can’t get time of work, or you can’t afford the transport costs. Many women have to sacrifice something to come to the hospital- when I studied this in our government clinic I found this included food, school fees and nappies. Even after you see a healthcare worker, they might not give you the right advice; sometimes they might reassure you that all is well because you are young, because you look healthy or because they are not up to date with current ways of investigating breast problems.

All these things may cause a may provide a barriers to good care, but it is important to remember that your own beliefs, fears and understanding of breast problems can provide a transparent, but equally important barrier to helping yourself. Even if you are afraid or you believe it is nothing, get to a breast specialist centre and get your breasts checked out. Then you can make sure you get the best care and the best outcome.