A common refrain in discussions about cancer in Africa is that “patients present too late.” While this is often true, it tells only part of the story. Encouraging early presentation is crucial, but without well-equipped healthcare systems, timely diagnosis and treatment remain out of reach.

When patients do take the right step by seeking medical attention early, they often still encounter long waits before receiving a diagnosis or starting treatment. These delays, caused by delayed diagnosis, limited diagnostic and treatment services, financial barriers, and weak referral systems, mean that even those who present early often end up with late-stage disease by the time they can access treatment.

Late stage diagnosis for cancer is the norm in many African countries resulting in limited or no treatment options, poor outcomes and low survival. Currently, approximately 70% of deaths from cancer occur in low- and middle-income countries. Strengthening health systems to improve early diagnosis and timely treatment is critical, especially as projections estimate that the number of cancer cases in Africa will double by 2040.

The Bottleneck: What Happens After Patients Seek Care?

A concerning statistic has emerged from studies done in several African countries, showing that over half of cancer-related delays occur after a patient’s first visit to a healthcare facility. In other words, even when patients take the right step by going to a clinic or hospital, the system often fails them.

These delays happen for many reasons:

• Delayed or missed diagnostic opportunities – Limited training and resource constraints in primary healthcare settings can make early cancer recognition challenging. As a result, patients may initially receive treatment for other conditions before a cancer diagnosis is confirmed.
• Limited diagnostic tools – Access to essential tests like biopsies, imaging, and pathology services is often restricted, especially in rural areas.
• Slow referral systems – Patients may bounce between multiple facilities before reaching a cancer specialist, wasting valuable time.
• Financial barriers – Even if the right tests are available, many patients simply can’t afford them.

The result? By the time a correct diagnosis is made, the disease has often progressed to an advanced stage.

Additional challenges patients face after reaching a treatment center include overcrowded facilities, particularly due to the limited number of specialized cancer centers, resulting in long wait times before treatment can begin. Even when treatment is accessible, frequent shortages of essential medications, including chemotherapy, often disrupt care, forcing patients to delay treatment or seek costly alternatives. Geographic barriers further compound the problem, as many patients live far from oncology units. The financial and logistical burden of repeated hospital visits can lead to further delays, ultimately compromising treatment outcomes.

Health-seeking behavior is more than awareness

Understanding and addressing the factors that influence health-seeking behavior are crucial in improving cancer outcomes in Africa. These behaviors are shaped by a complex interplay of individual beliefs, cultural norms, and systemic barriers. For instance, studies have identified that low symptom knowledge and negative beliefs about cancer universally hinder timely medical consultation. Additionally, socio-cultural factors, fear of diagnosis, and reliance on traditional practices contribute to delays in seeking care. ​

To effectively change health-seeking behaviors, especially among younger populations, innovative and non-traditional interventions are needed. Digital health tools, such as mobile health (mHealth) interventions, have shown promise in increasing cancer screening uptake. Combining multiple digital modes appears to enhance their effectiveness. Moreover, integrating artificial intelligence into cancer care can assist in early detection and personalized treatment strategies, potentially improving outcomes.

The Role of Trust: Why Some Patients Seek Alternatives First

In many African communities, traditional healers and faith-based practices are the first point of care for many illnesses, including cancer. This occurs often because:

• Traditional healers are more accessible and deeply rooted in community trust.
• Hospitals are seen as places of last resort, especially when previous experiences with the healthcare system were negative.
• The cost of hospital visits and diagnostic tests is simply too high for many families.

Building trust in the healthcare system is just as important as improving services. If people don’t believe they’ll get the care they need, they may delay seeking medical help or turn to alternative treatments first.

Nafula’s story

Nafula is a 33-year-old mother of two. One evening, while breastfeeding her youngest child, she noticed a small lump in her breast. At first, she dismissed it, thinking it was a blocked milk duct. When the lump didn’t go away after a few weeks, she visited the nearest health facility, a small clinic near her home.

The nurse reassured her that it was probably a normal breastfeeding-related swelling and advised her to apply warm compresses

Six months later, the lump had grown larger and firmer, and Nafula started feeling a dull ache in her breast and armpit. Her skin in that area darkened slightly, and at times, she felt sharp pain radiating to her back. She also noticed that she was losing weight despite eating normally. She tried herbal remedies, hoping for relief, but nothing changed.

When she returned to the clinic, the nurse was now concerned and referred her to a bigger hospital. But between taking care of her children, the cost of travel, and long queues at the hospital, Nafula postponed the visit multiple times. By the time she finally got examined three months later, her breast had become swollen, and the skin appeared thick and dimpled.

A biopsy was ordered, but with only one pathologist handling many cases, she had to wait another six weeks for results. In the meantime, she started feeling persistent back pain and a dry cough that wouldn’t go away. When the results finally came back, it was triple-negative breast cancer (TNBC).

Further scans confirmed the worst, it was already at stage 4, having spread to her spine and lungs.

Nafula needed immediate chemotherapy, but the hospital had run out of essential cancer drugs. She was advised to seek treatment in Capital City, but traveling there required money she didn’t have. With the help of family and well-wishers, she made it to the capital, but the costs of scans, medication, and transport quickly became overwhelming.

Through all of this, her biggest worry was her children. As she fought through the exhaustion of chemotherapy, hair loss, and pain, she feared what would happen to them if she didn’t make it.

What Are We Doing About It? APHRC’s Cancer Research Focus Area

The African Population and Health Research Center (APHRC) is actively working to address these challenges through its Cancer Research Focus area, in the Chronic Diseases Management (CDM) Unit.  With funding from the National Institute for Health and Care Research (NIHR), we are investigating delays along the cancer care pathway and developing interventions to reduce diagnostic and patient delays. Additionally, through support from the International Agency for Research on Cancer (IARC/WHO), we are working to improve breast cancer awareness. Our research also extends to quality of life for breast cancer survivors.

Moving Forward: Addressing the Bigger Picture

Improving early cancer diagnosis in Africa requires more than addressing late presentation. We must ensure that when patients seek care, they receive timely and effective diagnosis and treatment – without unnecessary delays. Building trust in healthcare systems, strengthening treatment pathways, and removing financial and logistical barriers are all critical to improving cancer outcomes.