Breast cancer remains the leading cause of cancer deaths among women worldwide. In Africa, where health systems are under strain, the World Health Organization (WHO) warns that without decisive action, the disease could claim about 135,000 lives by 2040. Every therapeutic advance therefore draws global attention—and with reason.

This year, that attention turned to Berlin, where two major clinical trials presented at the 2025 European Society for Medical Oncology Congress confirmed the efficacy of Enhertu, developed by AstraZeneca and Daiichi Sankyo, for early-stage HER2-positive breast cancer. In the most advanced trial, over 92% of women treated with Enhertu after surgery were alive and relapse-free three years later—a 53% reduction in recurrence or death compared to the current standard therapy. A second trial, testing the drug before surgery, showed higher rates of complete cancer disappearance. The word “cure” was cautiously mentioned, a rarity in oncology.

Such progress inevitably fuels hope. Yet it also exposes a quieter truth: as developed nations debate optimal treatment protocols, women in sub-Saharan Africa still face late diagnoses—often when cancer has already metastasized. The gap widens, not only technologically but structurally, politically, and humanly.

Early Detection, Timely Care

Aggressive breast cancers, especially HER2-positive types, progress rapidly but are highly treatable when detected early. Screening, imaging, treatment access, and continuity of care are essential. Yet these remain out of reach in many African countries.

A 2025 WHO report noted that only five of 47 sub-Saharan nations have organized breast cancer screening programs. Most rely on opportunistic detection when patients visit hospitals. Shortages of specialized medical staff and pathology labs compound the problem—only two countries meet the minimum standard of one lab per 100,000 people.

Even basic mammograms are unaffordable for many families. And diagnosis does not guarantee treatment. As of 2022, 16 sub-Saharan countries had no radiotherapy equipment, and five lacked chemotherapy access. Many women travel hundreds of kilometers for consultations or treatments they ultimately cannot afford. In these realities, “cure” is a distant notion; survival is the struggle.

Progress Exists, but Inequality Persists

There have been real, if uneven, improvements. Over the past decade, several African countries have adopted national cancer control plans. According to the International Atomic Energy Agency’s DIRAC database, 11 new radiotherapy centers opened in 2022 and 2023, bringing the total to 39 African countries with at least one facility.

UN News reported earlier this year that 27 African nations now have at least one oncology center, with Algeria and Kenya leading (10 or more centers each), followed by Nigeria, Botswana, Ghana, and Ethiopia. Others—especially in Central and West Africa—remain without public oncology infrastructure.

These disparities shape daily realities. In many places, getting diagnosed or treated remains an obstacle course. Patient associations, often founded by survivors, play a vital role in emotional, logistical, and sometimes financial support. In Senegal, chemotherapy for breast and cervical cancers has been free since 2019, though many indirect costs persist. For some families, care still means debt or asset sales.

Private initiatives have emerged as well. In August 2024, the European Institute of Oncology (IEC) opened in Abidjan—the first private cancer center in Côte d’Ivoire—offering care at one-third of European prices. Equipped with a state-of-the-art linear accelerator and artificial intelligence tools, it can treat up to 1,800 patients annually.

Still, the gap between medical innovation and African health realities remains wide. If Enhertu’s effectiveness is confirmed, how will it reach those who need it most? Cost is a key concern. Such targeted drugs, born of complex biotechnologies, are expensive, and pharmaceutical companies have yet to outline strategies for affordable access beyond wealthy markets.

Infrastructure is another challenge. Even the best medicine requires systems capable of prescribing, monitoring, and managing side effects. Enhertu can cause lung inflammation requiring rapid diagnosis—a near-impossible task where scanners are scarce. Fighting cancer begins not with a drug but with a clinic, a consultation, a screening.

The future depends on several choices: African governments’ willingness to invest sustainably in prevention, training, and healthcare infrastructure; international organizations’ commitment to make cancer a global priority; and pharmaceutical companies’ readiness to extend innovation beyond rich markets.

Enhertu’s promise reveals more than scientific progress—it highlights a growing medical divide. Lives can be saved, yes, but not equally. Hope exists, but it is not yet universal.

Louis-Nino Kansoun