Beyond pink ribbons: Why Kenya's breast cancer care is still failing women where it matters most

Yet, for all our pink ribbons and awareness campaigns, access to comprehensive care and surgical options remains very limited.

Time and again, women will share with me how they were given just days to make massive decisions about their bodies. Remove part, or all of their breasts? Immediate reconstruction or wait? Implants or using their own tissue? These aren't just medical choices; they touch the core of a woman's identity, her sense of self, her intimate relationships.

I've also held hands with countless women who broke down not because of their diagnosis, but because they felt pressured to make snap decisions without fully understanding their options. I've watched them choose mastectomies when they didn't need to, simply because no one took the time to explain alternatives.

Some of my patients only learned about reconstruction possibilities after their surgery.

Here's where the system gets it wrong: breast cancer surgery is classified as urgent, not emergent. International guidelines recommend initial treatments or surgery within 4-6 weeks of diagnosis. This window exists for good reason. It's not just about emotional readiness.

A breast cancer diagnosis usually prompts additional tests and imaging that need to be performed and a multidisciplinary team discussion that is needed to develop a personalised treatment plan.

Once surgery is deemed to be the initial option, additional time might be needed to control for other conditions that the patient might have. This may involve correcting raised blood pressure, stopping blood thinners safely, controlling diabetes to ensure the best possible surgical outcomes and minimise surgical complications.

Breast cancer surgery is elective, meaning it is planned. We can, and should therefore, take time to get it right.

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However, women have been scheduled for theatre within 48 hours of hearing they have cancer. The shock hasn't settled. They haven't processed what's happening. They're making permanent decisions about their bodies while still in crisis mode.

The irony? This rushed approach often creates more problems than it solves. I've counselled women experiencing severe psychological fallout after surgery because they didn't have time to fully process their decision-making.

What's missing from the conversation? Here's something you might not see or appreciate in pink ribbon campaigns: breast cancer isn't one disease. Each type is unique, requiring different approaches and treatments - just as Panadol and Brufen both treat pain but work completely differently.

Every case deserves review by a full team of specialists before any surgery or therapy happens. This isn't fancy extra care but basic best practice.

Women should know all their choices: Breast-conserving surgery can be just as effective as full removal, reconstruction can happen during the initial surgery or later, there are techniques to save skin and nipples, and various reconstruction options exist using their own tissue or implants. These aren’t merely cosmetic details, as they may help to enhance long-term wellbeing and body image perception post-surgery.

The real scandal isn't really about awareness, but more about access. Sometimes medical factors limit some surgical options or make them unsafe. However, many times, the real issue is the patient’s ability to pay and insurance coverage. Unfortunately, breast reconstruction is often considered cosmetic, and patients frequently have to pay out of pocket to cover the costs.

In my practice, we do recognize that women need time to process. They may need repeat conversations, psychological support, the need to involve their families and additional information in order to arrive at a shared decision.

If we're serious about improving breast cancer care, we need to adopt the following measures: Mandatory multidisciplinary review for every breast cancer case, protected time for decision-making optimizing the recommended window period to ensure the patient is prepared physically and psychologically, reconstruction as an essential part of the holistic management of breast cancer surgery and care and lastly, encourage shared decision making between multidisciplinary teams and patients.

This October, let's move beyond pink ribbons. Let's push for real change in how we treat women facing breast cancer and demand healthcare that respects their dignity and their right to make informed choices.

Because while surgery might take hours, the long-term decisions that shape a woman's future should not be rushed.

Dr Mutebi is an Assistant Professor, Department of Surgery, Aga Khan University Medical College, and Consultant Breast Surgeon, Aga Khan University Hospital, Nairobi.