🇿🇦 Cancer in South Africa

The GLOBOCAN 2024 fact sheet gives 15,060 prostate cancers (5,281 deaths), 13,338 breast cancers (5,377 deaths), 9,794 cervical cancers (5,165 deaths), 7,693 lung cancers (6,732 deaths) and 6,816 colorectal cancers (3,676 deaths). In men the leading cancers are prostate, lung and colorectum; in women breast, cervix and colorectum. The cumulative risk of developing a cancer before 75 is 20.4% for men and 15.2% for women, and an estimated 240,745 people are living within five years of a diagnosis. The National Cancer Registry's laboratory count for 2024 shows the same order in women, breast (11,264) then cervix (8,382), and puts prostate cancer first in men (10,769), ahead of basal cell skin cancer (8,732). Its childhood registry counted 3,032 cancers in children and adolescents aged 0 to 19 in 2022 and 2023, an age-standardised rate of 68.4 per million, with leukaemias, lymphomas and brain tumours the commonest groups; the report attributes the rise from 57.7 per million in 2019 to better case finding rather than more cancer.

Regulation R. 380 under the National Health Act, gazetted on 26 April 2011, established the National Cancer Registry in law under the National Health Laboratory Service and made cancer reportable: a health establishment confirming a diagnosis must notify the registry within three months, and laboratories must report every quarter. Laboratories send cases diagnosed by histology, cytology or bone marrow, and the registry publishes counts and rates by sex, age and population group; its tables for 2024 were published in 2026. Because this method excludes cancers diagnosed clinically, radiologically or at death, the registry built population-based registries: Ekurhuleni, chosen because it includes all four of South Africa's main population groups, counted 4,914 cancers in 2024, the highest in its eight years, with 96.6% confirmed under the microscope; eThekwini counted 3,923, with 69.6% confirmed. The Ekurhuleni report says a cyberattack on the National Health Laboratory Service and a new patient identification system delayed case confirmation, so the 2024 total likely modestly underestimates true incidence; its discussion adds that the cyberattack disrupted both 2023 and 2024, that 2023 was artificially low, and that part of the 2024 rise, such as cervical cancer's rate jumping from 14 to 35 per 100,000, reflects retrospective back-capture of manual records rather than a true increase. The report says further registries are planned in the Western Cape and Limpopo but need a formal government funding commitment.

The National Essential Medicines List Committee's 2026 trastuzumab review estimates that approximately 85% of the South African population relies on the public health sector. The Council for Medical Schemes' annual report for 2025/26 counts 70 registered schemes, 16 open and 54 restricted, covering about 9.17 million beneficiaries in 2024, up from 9.13 million in 2023, which is about 14% of IARC's 2024 population estimate of 64.0 million; the Ekurhuleni registry report puts the share with medical insurance at 16%. Schemes paid R259.3 billion in benefits in 2024, and members paid a further R46.3 billion out of pocket. Every scheme option must cover the Prescribed Minimum Benefits: emergency care, 271 listed conditions and 26 chronic conditions in the 2025/26 report. The council's consumer guide lists cancers by site, each qualified as treatable, paired with medical and surgical management including chemotherapy and radiotherapy, plus cervical and breast cancer screening, and says schemes must pay for these in full without a co-payment or deductible; a co-payment can apply if a member chooses a medicine off the scheme's formulary or a provider other than its designated one.

The committee's tertiary and quaternary list of July 2026 records, among cancer medicines, imatinib for chronic myeloid leukaemia and for gastrointestinal stromal tumours, dasatinib or nilotinib after imatinib, rituximab for first-line diffuse large B-cell lymphoma except patients with an International Prognostic Index of 0, lenalidomide for newly diagnosed myeloma (approved 8 December 2022), bortezomib on special access for transplant-eligible myeloma, and fulvestrant for hormone receptor-positive advanced breast cancer as third- or fourth-line therapy, approved on 30 July 2026 with the note that a reference price was met, after a decision not to approve it in March 2021. Not approved are, for example, pemetrexed for lung cancer and mesothelioma, temozolomide for glioblastoma, and rituximab for indolent B-cell lymphoma, where the committee wrote that despite better response rates it is deemed unaffordable at its current price. Trastuzumab for early HER2-positive breast cancer was listed in 2017 for 12 months, cut to 6 months in 2019 after the PERSEPHONE trial, and on 4 June 2026 extended to treatment before surgery and to locally advanced disease; the review notes its cost has fallen 59% over eight years. No immune checkpoint inhibitor appears among the list's reviewed items, and abiraterone and enzalutamide appear only in a review note for docetaxel in prostate cancer, not as reviewed items. New items are to be sourced on a national quotation, where possible, until a national tender is in place.

The National Health Insurance Act 20 of 2023 was assented to on 15 May 2024; its commencement is to be proclaimed. It establishes a National Health Insurance Fund to purchase health care services strategically on behalf of users, and section 33 provides that once national health insurance has been fully implemented, as the Minister determines by regulation, medical schemes may only offer complementary cover for services not reimbursable by the fund. On 24 February 2026 the Presidency said that, because of litigation against the President and the Minister of Health, the President had agreed with the Minister to delay the proclamation of any sections of the Act until the Constitutional Court hands down judgment in challenges to the public participation process, due to be heard on 5 to 7 May 2026. Eyewitness News reported on 7 May 2026 that the court had reserved judgment in the combined applications of the Board of Healthcare Funders and the Western Cape government, and that the ruling is expected to clarify more than a dozen related cases. The Council for Medical Schemes' 2025/26 report notes the uncertainty for schemes, providers and members while there is no clear definition of when national health insurance is fully implemented. The Act does not set out a list of cancer services, so what it would cover for cancer is not yet known.

SAHPRA's reliance guideline, SAHPGL-BAU-01 version 4 of May 2024 (first published in July 2019), describes three routes. An abridged review is based primarily on full assessment reports from a recognised regulatory authority; a verified review checks a product against one already approved by SAHPRA or such an authority; and recognition would accept the outcome of a review by an authority with which SAHPRA has a recognition agreement, which the guideline says SAHPRA was still negotiating. To qualify, a medicine must have been approved by at least one of: the European Union's centralised or decentralised procedure, Health Canada, the UK's MHRA, Japan's PMDA, Swissmedic, Australia's TGA, the US FDA, or a WHO-listed authority. The guideline follows the World Health Organization's definition of reliance, under which the relying authority remains responsible for its decision. A study of SAHPRA's approvals in 2020 found that approval timelines for applications in its backlog stream, assessed through facilitated pathways such as abridged and verification review, were 68% quicker for new chemical entities and generics alike; the abstract does not name the comparison, and business-as-usual applications all had a full review. SAHPRA also handles Section 21 applications, its route for access to medicines that are not registered in South Africa.

SAHPRA's 2024/25 Annual Performance Plan sets output targets of 80% of new chemical entity applications finalised within 360 working days in 2024/25, 320 in 2025/26 and 300 in 2026/27, and of 75% of generic applications within 250 working days, rising to 85% in later years. It reports earlier results against looser targets: in 2021/22, 44 of 246 new chemical entity applications received were finalised, all within 590 working days; in 2022/23 none was due for finalisation and 89 were finalised within 490 working days. It describes a Policy on Priority Review Pathways, approved by the Board and in use since the last quarter of 2021/22, for new medicines that address an unmet clinical need, show a major therapeutic advantage, or treat life-threatening or seriously debilitating conditions or rare diseases. The plan records that SAHPRA obtained the World Health Organization's maturity level 3 in 2022/23, which it describes as a stable, well-functioning regulatory system for vaccines, and aims for level 4; it was designated a Regional Centre of Regulatory Excellence for vaccine regulation in August 2023. OnCo could not open the 2024/25 annual report, so whether the 360-day target was met is not given here; see the gaps.

The Department of Health's Cervical Cancer Prevention and Control Policy of June 2017 provides three free screening tests at ten-year intervals for HIV-negative, asymptomatic women over 30 attending public health services, with three-yearly repeat screening after an abnormal result until it is negative. Women living with HIV are screened irrespective of CD4 count and antiretroviral treatment, at three-yearly or annual intervals depending on the result, for life. The policy keeps cytology, introduces HPV DNA testing where resources permit and screen-and-treat with visual inspection in resource-limited settings, and set a goal of reducing invasive cervical cancer from 31.7 to 20 per 100,000 women by 2022. It noted that despite a national screening programme since 2002 incidence had remained unchanged, and gave screening coverage of women aged 30 and over as 54.5% in 2014/15 and 57.4% in the second quarter of 2015/16. Using National Cancer Registry data, Shing and colleagues measured cervical cancer incidence of 30.4 per 100,000 women a year in 2011 to 2021, stable until 2016 and then declining by an average of 2.7% a year, while vulvar, vaginal, penile and anal cancers rose.

The programme began in 2014 for Grade 4 girls aged 9 and over through the Integrated School Health Programme, and reached 87% coverage with at least one of two doses, according to Machalek and colleagues. Comparing self-collected samples from girls aged 17 to 18 at 15 clinics in four provinces in 2019 (819 girls) and 2023 (1,538), they found HPV 16 or 18 prevalence fell from 21.6% to 3.2%, an adjusted prevalence ratio of 0.17, and among girls living with HIV from 29.4% to 4.4%, similar to the effect of three-dose programmes in high-income countries. In August 2026 the Gauteng Department of Health said its campaign, running to 9 October 2026, offers a single dose of Cervarix to Grade 5 girls aged nine and older, that more than 80,000 girls were vaccinated in 2025/26, and that learner absenteeism, 24,327 unreturned consent forms and misinformation held uptake back; it said no learner is vaccinated without a signed consent form, although learners aged 12 and older may consent for themselves. OnCo did not find a current national coverage figure.

The Department of Health's Breast Cancer Prevention and Control Policy of 2017 sets as its first standard that women over 40 attending a primary health clinic have a clinical breast examination by a provider biannually, the policy's word, with breast education and awareness for all. It states that screening mammography should not be introduced unless resources are available to screen at least 70% of the target group, women aged 50 and older, reliably and effectively, that lack of resources and infrastructure in the public system makes this untenable, and that mammography should be performed on symptomatic and identifiable high-risk women at specialist breast units. Women the policy lists as at increased risk, including carriers of BRCA1 or BRCA2 variants and women with a first-degree relative with breast cancer, should be encouraged to have yearly mammography from 40 to 50 and yearly or two-yearly from 50. For people with medical scheme cover, the Prescribed Minimum Benefits include cervical smears and periodic breast examination. The registry's Ekurhuleni report finds the highest breast cancer rates among White women in that district.

The South African HIV Cancer Match Study links HIV-related laboratory records from the National Health Laboratory Service to the National Cancer Registry. Ruffieux and colleagues followed 5,222,827 people living with HIV from 2004 to 2014 and found 29,580 cancers, most often cervical cancer (7,418), Kaposi sarcoma (6,380) and breast cancer (2,748); at age 40 cervical cancer was the commonest in women and Kaposi sarcoma in men, whose rate peaked at age 34, and after about age 54 cancers not caused by infection overtook those that are, with prostate cancer the commonest in older men. A 2026 analysis by Metekoua and colleagues of 496,517 cancers in the registry from 2004 to 2021 found that only 41% had a documented HIV status, rising from 29% to 52% over the period; where status was known, 75% of people with infection-related cancers and 32% with other cancers were living with HIV. The registry still counted 794 Kaposi sarcomas confirmed by a laboratory in 2024. National cervical screening policy treats every woman living with HIV as high risk and screens her more often for life.

According to a summary of the judgment by the law firm Werksmans, on 27 March 2025 the High Court in Johannesburg, in Cancer Alliance v Member of the Executive Council for Health, Gauteng ([2025] ZAGPJHC 136), granted urgent interim relief. Cancer Alliance argued that the department had failed to use R784 million allocated by the Gauteng Treasury in March 2023 to address surgical and radiation oncology backlogs, of which R250 million for outsourcing radiotherapy was returned unspent, and the court found that the department had, without justifiable reason, ignored the patients' right to outsourced radiotherapy paid for from those ring-fenced funds; Spotlight reports the unspent allocation as the background to the ruling. It ordered the department to update the Cancer Alliance's backlog list within 45 days, take all necessary steps to provide radiotherapy to backlog patients at Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital, and report within three months on its steps and long-term plan. The department appealed to the Supreme Court of Appeal; in August 2025 a judge ordered the March order enforced in the meantime, and the department said 563 patients were receiving radiotherapy through private partnerships and 1,076 had completed treatment by the end of July 2025. In December 2025 a full bench of three judges suspended the order pending the appeal, finding the department had prospects of success. OnCo did not find the appeal's outcome.

Counted from ClinicalTrials.gov participation data in OnCo's graph on 4 November 2026: 155 trials list South Africa among their countries, 132 of them phase 3, 11 phase 2, 8 phase 2/3, 3 phase 1/2 and 1 phase 1. ClinicalTrials.gov shows 29 recruiting, 79 active but not recruiting, 41 completed and 6 terminated, and names Merck Sharp & Dohme as lead sponsor of 23, Roche of 18, AstraZeneca of 17 and Pfizer of 13; non-small cell lung cancer (22), prostate cancer (19) and triple-negative breast cancer (14) are the commonest first conditions. Among those with the fewest countries, NCT07125872, an ImmunityBio phase 2 study in relapsed or refractory B-cell non-Hodgkin lymphoma, lists only South Africa; ECOG-ACRIN's EA1131 trial in triple-negative breast cancer ran in the United States and South Africa; and ACTG A5263, in six countries, found that oral etoposide and bleomycin with vincristine were worse than paclitaxel for advanced Kaposi sarcoma in people with HIV. OpenAlex counts 1,934 oncology papers with a South African author from 2021 to 2025, rising from 374 in 2021 to 436 in 2025, 1,514 of them open access, and ClinicalTrials.gov counted 3,864 studies of any condition with a site in South Africa when OnCo built its country file on 8 September 2026.

Statistics South Africa publishes Mortality and causes of death in South Africa (P0309.3); the 2024 edition's PDF returned a bot-protection page to a plain request on 4 November 2026 and the Internet Archive held no copy, so registered cancer deaths could not be compared with IARC's 55,356. IARC's fact sheet says its South African mortality comes from national death data supplied through the WHO and projected to 2024. The Ekurhuleni registry report says survival and outcomes are not available from any existing South African registry and that a concept to embed registries in the South African Population Research Infrastructure Network aims to provide them. The registry's 2024 national report is a set of tables without a written methods section, so this page takes its methods from the registry's web page and its population-based reports.

SAHPRA's annual report for 2024/25 is linked from its website as a SharePoint file that returned no document to a plain request on 4 November 2026. The 2024/25 Annual Performance Plan gives targets and results only up to 2022/23. The most recent peer-reviewed measurement read here is of approvals in 2020. Whether a registered cancer medicine is on the public essential medicines list, stocked by a province, or covered by a given medical scheme are separate questions this page cannot answer medicine by medicine; the essential medicines list itself is the July 2026 version.

The newest national cervical screening coverage figure found is the 57.4% for 2015/16 quoted in the 2017 policy. The HPV vaccination figures are the 87% one-dose coverage of the original two-dose programme, from a 2026 paper, and Gauteng's count of more than 80,000 girls in 2025/26; no national single-dose coverage was found. No official count of radiotherapy machines or oncologists in South Africa was read for this page. The Constitutional Court had not ruled on the national health insurance challenges when this page was written, and the Supreme Court of Appeal's decision in the Gauteng radiotherapy case was not found; the March 2025 judgment itself is described from a law firm's summary because the court's published text did not load.

The consumer guide lists 270 diagnosis and treatment pairs and 25 chronic conditions, while the 2025/26 annual report gives 271 conditions and 26 chronic conditions, so the list has been amended since the guide was written. The guide pairs cancers with medical and surgical management including chemotherapy and radiotherapy where the cancer is treatable; it does not define treatable, and schemes apply their own protocols, formularies and designated providers, which can decide what is paid in full. The council also publishes benefit definition guidelines for specific conditions, which OnCo did not read for this page. A member who disagrees with a scheme's decision can complain to the council, which registered 2,455 formal complaints in 2025/26.