Breast cancer in Africa set to double by 2045, warns leading Egyptian oncologist

Breast cancer rates in Africa are set to double by 2045, warns leading Egyptian oncologist Professor Hesham El-Ghazaly in this interview with Ahram Online, citing late diagnoses, limited care, and lifestyle shifts as drivers of a growing crisis—one Egypt is tackling through mass screening and precision medicine.

In the following interview, El-Ghazaly—Professor of Oncology and Director of the Research Centre at the Faculty of Medicine, Ain Shams University, as well as a member of the International Agency for Research on Cancer (IARC) and the Africa Breast Cancer Council—discusses the regional trends, breakthroughs in treatment, and Egypt's model for early detection.

Ahram Online (AO): Could you shed light on the rise in certain types of cancer in recent years?

Dr. Hesham El-Ghazaly (HG): Breast cancer is the leading cause of cancer-related deaths among women in Africa, driven primarily by a lack of awareness of symptoms, limited access to healthcare due to geographical and financial barriers, late diagnosis, and restricted treatment options.

Cultural beliefs and misconceptions also play a role, with many women ignoring symptoms or turning to traditional healers. This often delays diagnosis and increases the risk of late-stage cancer.

Even after diagnosis, the high cost of breast cancer care and fear of financial burden often result in women not pursuing treatment.

Breast cancer rates in Africa are expected to double by 2045 due to increasing life expectancy and changing lifestyles. Unfortunately, the proportion of breast cancer cases on the continent is significantly higher than in Western countries.

AO: What are the figures in this regard, and what studies support them?

HG: Africa has the highest breast cancer mortality rates globally, with only 50 percent of women expected to survive five years after diagnosis, compared with 90 percent in high-income countries.

In fact, 77 percent of African women are diagnosed too late. Those who are diagnosed often do not receive the treatment they need.

In Egypt, the breast cancer incidence rate is 55.4 per 100,000 women, with an estimated 26,845 new cases recorded in 2022.

AO: In Africa—and Egypt specifically—what factors are driving these trends?

HG: The World Health Organization predicts the number of breast cancer cases in Africa will double to 400,000 by 2045. This is primarily due to longer life expectancy and lifestyle changes, including five key risk factors: smoking, alcohol consumption, high body weight, elevated blood sugar, and lack of exercise.

In Egypt, contributing factors include high body mass index (BMI), physical inactivity, the uncontrolled use of hormone replacement therapy, and possible genetic influences.

AO: What are some of the most promising advances in cancer treatment? And which initiatives have had the most positive impact in Egypt?

HG: Egypt's Presidential Initiative on Women's Health has had a major impact, significantly reducing the percentage of women presenting with late-stage breast cancer and cutting the time between symptom recognition and diagnosis. We have screened 34 million women over four years—an approach that can serve as a model for other countries aiming to improve breast cancer care.

The Africa Breast Cancer Council—of which I am a member—is another key initiative. Launched in October 2024 during Breast Cancer Awareness Month, the council brings together economists, healthcare professionals, oncologists, first ladies, and former ministers to advocate for systemic change to improve survival rates across the continent.

AO: Personalised or precision medicine is a growing focus in oncology. How far has Egypt come in tailoring treatments to individuals based on genetics?

HG: Precision medicine is about achieving the best outcomes with the fewest side effects. Egypt has made strong progress in this area. We've improved pathology services across governorates and, in collaboration with a pharmaceutical partner, are now distinguishing between biological subtypes of breast cancer.

This has allowed us to avoid chemotherapy in certain early-stage cases—about 35 percent—and instead offer simple oral adjuvant treatments depending on hormone levels.

It also helped us identify HER2-positive cases and begin targeted treatment before surgery, resulting in a 77 percent complete pathological response rate at the time of surgery.

We've also begun to build significant capacity for genomic testing and comprehensive analysis, supported by the Ministry of Higher Education, the Ministry of Health, and military research centres.

AO: Immunotherapy has been described as a breakthrough. Is it living up to expectations in Egypt?

HG: Immunotherapy is the fourth major pillar of systemic cancer treatment, alongside chemotherapy, hormone therapy, and targeted therapy. It has shown impressive results in several cancer types, especially "hot" tumours such as melanoma, lung cancer and renal cell carcinoma.

Thanks to efforts by the Unified Procurement Authority and the Egyptian Drug Authority, we've managed to include immunotherapy in national treatment guidelines in a cost-effective way. It's also covered by the new Universal Health Insurance system. Moreover, public-private partnerships have enabled us to begin local manufacturing of these promising therapies.

AO: Finally, what advice would you give to help prevent cancer, particularly in Egypt?

HG: Adopting a healthy lifestyle is crucial in lowering cancer risk. According to the World Health Organization (WHO), this includes avoiding tobacco and alcohol, exercising regularly, maintaining a healthy weight, and eating a balanced diet.

On a national level, it's essential to ensure systems are in place for regular screening, which is key to early detection and effective treatment.

From : Al-Ahram