Breast Cancer Awareness Month; Awareness and Care

Every October, the pink ribbons and awareness walks remind us: breast cancer is not just a woman’s issue, it is a public health crisis. In Malawi, where many women live far from hospitals, screening and treatment have been sketchy for too long. But there is hope; new centres, stronger plans and growing awareness are bringing change.

A study of pathology reports from 2011 to 2013 among 85 breast cancer patients, showed that nearly half of the patients had grade-3 tumours (which are more aggressive) and the median tumour size was about 4 cm at diagnosis. Also, symptom duration which is the time between noticing symptoms and diagnosis was eight months on average. Additionally more than half the patients were under 50 years old. This is however concerning because it means younger women are getting it too and often later. According to SCISPACE.

These findings suggest that many women in Malawi are not getting early detection, might be because they don’t know the signs or because there are barriers to access. There are systematic reviews of breast and cervical cancer screening services in Malawi, which show that raising awareness for instance through talks or community education can significantly increase uptake of screening services. Even though that’s the case awareness is still low in many areas. The same review noted that in many communities, women had never heard of screening and/or had very little knowledge of breast cancer causes or options for early detection. It is rural women that seldom access these screening services. The good news is NGOs/community groups, like Think Pink Malawi, are helping by organising awareness walks plus free screening in some places. These are good, but they tend to be short‐term and only in certain areas.

For many years, Malawi had no public radiotherapy centres, so cancer patients who needed radiotherapy had to travel abroad which meant huge costs for travel, accommodation, etc. This has improved as we have seen a development in this. For example, in Blantyre, the International Blantyre Cancer Centre (IBCC) which was opened in March 2024 offers screening, diagnostics, chemotherapy, radiotherapy and imaging. This is a major resource. In Lilongwe, the Malawi National Cancer Centre at Kamuzu Central Hospital which was opened in mid-2025, is being expanded with radiotherapy and brachytherapy bunkers, linear accelerators etc. The “Rays of Hope” initiative supports this and the new Cancer Centre is expected to treat up to 100 patients daily, providing free treatment.

Nevertheless, a concerning issue is that most screening services are concentrated in cities while women in rural areas often do not have clinics nearby that do breast exams or awareness outreach. To them travel costs, poor roads and lack of public transport for instance are big issues. To add to that many don’t know what early symptoms look like as they sometimes dismiss lumps or changes or fear the stigma, or think cancer equals death. By the time many come to clinics, the tumour is large. And even when they get there, pathological diagnosis is limited. Sometimes the labs or imaging aren’t available or results take too long. This delays treatment. Though treatment at new centres is free or heavily subsidized, indirect costs like travel, lodging, food, time off work still hurt many women severely. Also, some programmes (screening outreach, awareness campaigns) rely on donor funds, which can be there or not.

With the opening of the Cancer Centres in both Lilongwe and Blantyre, radiotherapy is now available locally which is a huge step and there will be no more sending many patients abroad. The national cancer control strategic plan (2019–2029) reveals that it gives breast cancer early detection, diagnostic services and treatment high priority. It also added the Data collection improvements and the establishment of research cohorts (e.g. by UNC for breast cancer) are helping fill knowledge gaps: about tumour biology, risk factors, etc.

There is indeed an improvement when it comes to the services of Breast Cancer but there is still a lot that needs to be done. For example; scaling up community screening & detection, faster biopsy processing, more pathology labs, better quality of tests including hormone receptor testing and imaging and reducing indirect costs for women to make treatment not just “free” but accessible. Most importantly every October helps, but there is a need for year-round education, involving survivors and local leaders, using radio or local languages. It would also be great for the Government to allocate budgets and local philanthropic support to back cancer services.

Malawi is at a turning point. The opening of cancer treatment centres is not just symbolic, it changes lives. But marginalized women are still being left behind by gaps in awareness, screening,and access. For Breast Cancer Awareness Month, calls for change aren’t enough: what’s needed is consistent action, especially where it hurts the most; in rural communities, low-income families and remote districts. The true test of progress will be when a breast lump in a village gets detected early, diagnosed quickly and treated close to home for every woman in this country.