Impact of and recovery after Covid-19 on breast cancer diagnosis and care in Johannesburg, South Africa.

Authors

Rebaone Petlele, Raylton Prosper Chikwati, Olaide Olawumi Ojoniyi, Monica Ewomazino Akokuwebe, Wenlong Carl Chen, Nivashini Murugan, Phumudzo Ndwambi, Linda Kumirayi, Furhana Jassat, Sarah Nietz, Rofhiwa Margaret Mathiba, Karisma Singh, Phyllis Ohene-Agyei, Valerie McCormack, Shane Anthony Norris, Maureen Joffe

Published in

BMC cancer. Volume 26. Issue 1. Oct 03, 2026. Epub Oct 03, 2026.

Abstract

COVID-19 negatively impacted cancer diagnostic and treatment services worldwide. These challenges were further compounded in low- and middle-income countries, where longstanding resource constraints limited the capacity to maintain standard treatment pathways. We aimed to assess the impact of COVID-19 on (i) stage at diagnosis and time intervals from symptom recognition to a pathological confirmed breast cancer (BC) diagnosis and (ii) treatment initiation at two academic hospitals in Johannesburg; Chris Hani Baragwaneth Academic Hospital (Site 1) and Charlotte Maxeke Johannesburg Academic Hospital (Site 2).
We compared the proportion of BC cases diagnosed at a late stage (stage III/IV) and median time intervals of pre-contact (T₁), diagnostic (T₂) and treatment initiation following diagnosis (T₃) pre, during and post COVID-19 among 2522 women. Using cumulative Kaplan-Meier time-to-event analysis we assessed the proportions of women achieving internationally benchmarked intervals.
Late-stage BC diagnoses increased during COVID-19 but subsequently recovered, with pre-, during-; and post-COVID-19 percentages, respectively, of 50%, 60% and 53% at Site 1 and 63%, 69% and 55% at Site 2. Compared to pre-COVID-19, at Site 1 the T₁ interval increased during and post COVID-19 (from 0.8 (IQR: 0.3-4.0) months to 1.0 (IQR: 0.5-6.0) and 2.0 (IQR: 0.5-6.0) post COVID-19 (P < 0.001), respectively); there were no significant T₁ changes at Site 2. Delays more than 3 months were associated with late-stage diagnosis. T₂ intervals did not differ significantly across COVID-19 periods at both sites. The treatment interval (T₃) at Site 1increased from a pre-COVID-19 median of 1.6 (IQR: 1.0-2.6) to 2.0 (IQR: 1.2-4.3) during COVID-19 and remained at 2.0 (IQR: 1.1-4.0) post COVID-19 (P < 0.001); at Site 2 an increase also occurred during COVID-19 but was not significant. Internationally benchmarked staging and timeliness targets were never achieved.
The already high prevalence of late-stage at diagnosis increased further during the COVID-19 pandemic with evidence of recovery at both sites in the post COVID-19 period. Treatment initiation delays increased and surgery volumes decreased during the pandemic and did not recover to pre-pandemic levels. Our study shows current cancer human and facility resources are insufficient to manage the steadily increasing BC burden in Johannesburg, South Africa.

PMID:
42829437
Bibliographic data and abstract were imported from PubMed on 04 Oct 2026.

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