Doctor attacks South African government for failing women while spending billions on arms deals

drugs, notably aromatase inhibitors, taxanes, navelbine and trastuzumab are not available. Radiation equipment is outdated and breakdowns are frequent. Waiting times for radiation in breast conservation are four to six months," he said.

"Furthermore, in an environment with stagnating resources, policy priorities have shifted from tertiary services to primary health care, which is a laudable aim, but the concomitant starvation of tertiary services means they cannot handle the increased workload generated by the expanded primary services.

"There is no coherent breast cancer policy in place. In 2000 the Department of Health commissioned me to write a paper on screening. I suggested that a mammographic screening service in South Africa would cost about one billion rand (nearly 116 million euros) and was an unaffordable utopia that would be impossible to implement due to a lack of skilled mammogram readers. Therefore, I suggested a nurse-based clinical service, which would be implemented from the centre, starting with the large teaching hospitals and extending as the nurses were trained, to the peripheral primary care centres.

"This would cost about 42 million rand (about 4.8 million euros) for the whole country. Such a system was implemented successfully in Singapore. Unfortunately, contrary to Department of Health promises, the paper is still not even available on its website. As a result of this inaction in breast cancer care, women with breast problems present at a late, symptomatic stage and cure is often impossible. Surgery is the only treatment that is readily available."

Prof Apffelstaedt contrasted the 42 million rand that it would cost to set up a nurse-based clinical service with the 46 billion rand (about 5.2 billion euros) that the country spent recently buying four naval ships. "There are no obvious enemies of this country that would require defence at sea, making an investment in such major war machinery question

Contact: Emma Mason
Federation of European Cancer Societies

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