If breast cancer teaches us anything, it is that our bodies cannot wait for political promises, and that South African women deserve more than pink campaigns that do not translate into measurable change, writes Dr Liana Roodt in Daily Maverick.
Every October, the world turns pink. Corporates launch campaigns, cupcakes are baked, ribbons are pinned to lapels, and for a brief moment, breast cancer takes centre stage.
As a breast surgeon, founder of a breast cancer NGO that has faced this pink wave for 15 years, and most importantly, as someone who has walked beside thousands of women on their cancer journeys, I know how important awareness is. It gives us language, solidarity and visibility.
And yet, I am struck each year by how shallow the conversation often remains. Silence and carefully construed optimism are no longer an option for me – the conversation has to change.
Here is the hard truth: awareness, screening and the mantra that early detection saves lives become meaningless if women cannot access timely, evidence-based and dignified care. A mammogram is only as powerful as the treatment that follows it. A pink ribbon is only as meaningful as the impact it has to shift access to care.
The moral breach of delay
In South Africa, breast cancer is the most common cancer among women. Our 2017 National Breast Cancer Policy is progressive and well-intentioned, but implementation is patchy at best.
Women in the public sector routinely wait months, sometimes years, for diagnosis and treatment. By the time many reach oncology clinics, their disease is often already advanced. More concerning, even those who arrive with early stage disease may face the very real tragedy of disease progression as systems fail them.
Waiting for histology reports, waiting for staging investigations, waiting for surgery, waiting for a slot to receive radiotherapy. Waiting… Not to speak of the miracle drugs we know exist but are simply not available.
None of this happens because these women ignored awareness campaigns. The stories of these cancer patients are not simply a lack of education or a technical failure – it is a moral breach.
Waiting lists are not neutral bureaucratic inconveniences; they are silent rationing devices that decide, by default, who will live and who will not.
Pinkwashing and hollow solidarity
Every October, marketing departments flood the market with pink merchandise and “awareness” events. While many are well meaning, too often they stop at symbolism.
The bigger conversation is conveniently avoided.
We need to ask the uncomfortable question: after the pink ribbons and awareness education, after the self-examination, after the free screening initiative – what happens when something is found? This question does not devalue the critical role of all these initiatives.
However, we need to ask what happens when cancer is diagnosed but access to care is an uphill battle?
South African women do not need more pink balloons or hashtags. They need functioning diagnostic clinics, staffed and equipped laboratories and radiology services, adequate theatre slates, more chemotherapy chairs, radiotherapy machines that work, access to critical medicines, research that is based on our unique population and well-trained oncology teams.
Even those who have the privilege to access faster treatment in the private sector are too often victim to siloed, unco-ordinated care and exhausting battles with medical aids to cover certain procedures and drugs.
Solidarity without structure is hollow. A pink ribbon cannot replace a pathology report. Pretty posters cannot shorten a waiting list.
If government, corporates and individuals truly want to stand in solidarity, the real test is whether their investment and their message strengthen not only awareness but actual treatment and support for women who face a breast cancer diagnosis – by holding authorities accountable, funding oncology training, supporting cancer clinics or backing NGOs that bridge the gap between awareness and access to care.
Health equity is political
The health of women is not only a medical issue; it is a political and economic one. Equity in health is the measure of a just society, yet in South Africa, access to care is profoundly unequal.
Too often, when health inequity is raised, the default political response is the promise of National Health Insurance (NHI). In principle, universal coverage is a moral imperative. But the NHI, as currently framed, faces massive implementation challenges.
Passing legislation is not the same as delivering care. Without urgent investment in governance, infrastructure, staffing and accountability, the NHI risks becoming another promise deferred, another reason to wait.
In cancer care, waiting is not neutral. Waiting is death.
Recent failures
We do not need to imagine what happens when systems collapse; we have seen it. The Life Esidimeni tragedy, where more than 140 psychiatric patients died after being moved to unlicensed NGOs, remains a national wound.
The assassination of Babita Deokaran, a Health Department whistle-blower, is a chilling reminder of how corruption and mismanagement directly cost lives.
And this year, a landmark court case laid bare the same failures in cancer care. In Cancer Alliance v MEC for Health, Gauteng, the High Court ruled that the department’s failure to provide radiation oncology services to thousands of patients was unlawful and unconstitutional.
The court ordered urgent treatment, updated backlog lists and progress reports.
Yet rather than act, the Gauteng Department of Health has chosen to appeal, deny urgency and deflect responsibility – even while patients wait, deteriorate and die.
Taxpayer money is being spent on legal fees instead of life-saving care. This is not a bureaucratic oversight; it is a moral abdication of the state’s duty to protect life and dignity.
A global siren
Globally, research has shown that cancer outcomes are determined as much by politics and economics as by pathology.
Studies confirm that social determinants – income, education, geography and race – strongly shape survival rates (Nature Communications, 2024 and (PubMed, 2024).
An umbrella review found that women from lower socioeconomic groups face up to a 45% higher risk of dying after breast cancer.
The Lancet Commission on Women, Power and Cancer also highlighted how gender inequality functions as a global barrier to cancer care, influencing everything from resource allocation to access and policy (The Lancet Commission, 2023).
The World Health Organisation’s Global Breast Cancer Initiative stresses that reducing mortality requires not just early detection, but timely diagnosis and comprehensive treatment throughout the care pathway (WHO Implementation Framework, 2023).
Environmental exposures such as endocrine-disrupting chemicals also contribute to breast cancer risk, particularly in vulnerable communities (BMC Cancer, 2025).
And even where treatment exists, access is often shaped by economics: life-saving drugs such as trastuzumab remain out of reach for many in low- and middle-income countries due to prohibitive costs (JCO Global Oncology, 2020) and (PMC, 2024).
In short, breast cancer has become a megaphone: a disease through which unseen battles are fought between equity and exclusion, policy and neglect, science and profiteering. The bodies of women have become the battleground for these failures.
To reduce the cancer continuum to molecules and genes, while ignoring economics and politics, is to miss the point.
Beyond awareness to accountability
If we are serious about breast cancer, and about health equity more broadly, we must demand structural change. That means:
• Budgets that match the true burden of disease;
• Transparent governance and protection of whistle-blowers;
• Infrastructure and workforce strengthening;
• Decentralised but standardised services;
• Accountability in both the public and private healthcare sectors; and
• Civil society oversight to keep the government accountable.
These are not abstract reforms. They are the difference between life and death. Between dignity and neglect.
From pink to justice
Awareness without access to further care is not effective. It is window dressing.
What October has given us is a colour. But colours fade if it becomes washed out and diluted. Will I be wearing pink this October? Absolutely. Will I show up and support awareness and screening initiatives at every opportunity I get? Without a doubt.
But the pink I wear will come with a challenge – to add depth, truth and even discomfort, if necessary, to the Pinktober conversation.
If breast cancer teaches us anything, it is that our bodies cannot wait for political promises. South African women deserve more than pink campaigns that do not translate into measurable change.
They deserve timely, evidence-based, dignified care.
That is not only a medical demand. It is a moral one.
And that is real hope.
Dr Liana Roodt is a Specialist Breast and Endocrine Surgeon working in both the public and private sectors in Cape Town. She is the founder and Executive Director of Project Flamingo, a cancer NGO dedicated to improving timely, compassionate breast cancer care in South Africa, and serves on the Board of the Cancer Alliance of South Africa. She is also a lecturer in Surgery at the University of Cape Town, and brings to the fore the intersection of medicine, equity, and human dignity, with a strong focus on advocacy and health-system strengthening.
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