Patients and caregivers at the radiotherapy department at Uganda Cancer Institute on March 17, 2025. PHOTO/ TONNY ABET
Ms Nzila Warida, a resident of Arua City, almost lost hope after she was diagnosed with an advanced breast cancer that had spread to her lung.
However, following an aggressive treatment at the Uganda Cancer Institute (UCI) with drugs (chemotherapy), radiation therapy and surgery, the disease has been confined. This has restored her ability to engage in social and economic activities.
“I call myself now a cancer survivor because I have already reached one year plus,” Ms Nzila shares with Monitor, beaming with joy. “Now I’m not feeling so much pain.”
She reveals that before the diagnosis in Arua Regional Referral Hospital on October 17, 2023 she had noticed changes in the skin colour around her nipples. This caused her worry and confusion. But beyond that the colour changes, she majorly experienced headaches.
55% cancer burden in women
Ms Nzila represents thousands of women who develop different types of cancers each year in Uganda.
Dr Nixon Niyonzima, the head of training and research at UCI, says the cancer burden in the country remains highest among women.
“Of all the patients that we are seeing, 55 percent are females. The commonest cancer in Uganda is cervical cancer and among the commonest five, we also have breast cancer. That explains the 55 percent,” he observes. “But we also think that women seek care more easily than men do. 45 percent of the patients are men, and of course, prostate cancer is one of the top five cancers.”
The International Agency for Research on Cancer (IARC) indicates that of the 35,968 cancer cases Uganda recorded in 2022, 15,459 were among males while 20,509 were among females.
IARC indicates that among men, cancer of the prostate, kaposi sarcoma and cancer of the oesophagus are the leading types while in women the top four cancers are cervical, uterine, breast and kaposi sarcoma.
According to data from the UCI, there are 7,945 new cancer cases registered at the Kampala-based treatment centre. This is close to double the average of 4,000 new cases registered yearly there, indicating an increase. This increase partly explains the overwhelming number of patients in the facility.
Dr Jackson Orem, the UCI director, said to address rising numbers, they are constructing new facilities within Kampala treatment centre and in regions as well as acquiring better equipment and recruiting more healthcare workers to handle patients.
Additional information from UCI also shows that annually, around 36,000 develop cancer in Uganda and around 20,000 die, meaning many die without seeking the right diagnosis and care.
There are other cancer treatment centres in Gulu, Mbarara and other private facilities in Kampala but the number of patients handled combined, is much less than those at UCI.
Dr Naghib Bogere, a cancer specialist at UCI, says they are also registering breast cancer cases among men. However, he notes that although male breast cancer can be very aggressive (spread faster), breast cancer cases are majorly in women.
According to Dr Bogere, whenever breast cancer spreads to the chest, it is at stage three or above, meaning it is already advanced. “And when it goes to the chest, it spreads to the rest of the body,” he adds.
Advanced cancer is difficult to treat and the chance of survival reduces .
Dr Niyonzima says they want to detect cancer as early as possible and calls on the general public to always look out for the symptoms and also go for screening.
“The recommendation for screening is a routine breast examination which you should do on your breasts every month. When you feel any abnormality, you come to the hospital. We also have clinical examinations,” he advises.
“When you have a family history, you have to come for a mammography or ultrasound every year when you clock 35 years. If you have no family history, you should come for an examination when you reach 40 years old. But we want you to come as soon as you feel any abnormalities in the breast,” he adds.
“Now, there's no known association between sucking of breasts and breast cancer. If somebody has told you that if they suck your breast it is going to prevent breast cancer instead of coming for screening, they have lied to you,” Dr Niyonzima clarifies.
Missed opportunities
Dr Martin Origa, a consultant heading the department that handles cancer of the female reproductive system at UCI, says the country is not taking advantage of available methods to prevent cancers among women.
“The commonest cancer we have that affects women and even kills them is cancer of the cervix. On average, we see four to five new patients with cancer of the cervix daily, and that translates to more than a thousand new patients with cancer of the cervix per year," Dr Origa observes.
For, the year ending 2024, according to the World Health Organisation (WHO) indicated that the country had about 6,700 new patients with cancer of the cervix.
“Of those, about 4,200, are estimated to have died. That tells you that more than 50 percent of our patients who present with cancer of the cervix as a country, present with advanced stage disease, that is stage three and stage four,” Dr Origa says.
“When a patient presents with stage 3 and stage 4. When a patient presents with stage 3 and stage 4, our interventions are geared at palliative care. Palliative means that we are prolonging life. We're no longer talking about cure.
“So, if over 80 percent of our patients are presenting at that stage, we have a big problem, however, there have been a lot of efforts by the Ministry of Health, together with implementing partners to try and ensure that we eliminate this disease. That means we have to improve vaccination and also screening,” he adds.
The Health ministry has a policy on Human papillomavirus (HPV) vaccination, which is geared towards preventing cancer of the cervix. This is mostly for girls who are 9 to 13 years old.
However, Dr Origa says despite evidence that the vaccine protects against cervical cancer caused by HPV, the uptake of the vaccine hasn't been so good.
“We've been giving that two-dose vaccine. We found that the first dose has a good uptake of about 70 percent, but the second dose is the one that has had issues. Most of our young girls don't come back for the second dose,” he notes.
“However, the WHO has now changed the policy and the Ministry of Health has also changed the policy. We are now going towards the one-dose vaccine, which is very convenient and I would like to emphasise that this vaccine works,” he adds.
The expert also dismisses claims that vaccines affect the ability of girls to produce later in life. “People have fears about the vaccine that it will end the reproductive cycle of young girls; this hasn't been validated anywhere. So I strongly encourage our young girls to get the vaccine,” he adds.
However, for those who are not able to get the vaccine, Dr Origa says they should start screening at 25 years. Cancer of the cervix doesn't happen in a day, it takes 10 to 15 years.
