Milka Omolo’s seven-year struggle for a breast cancer diagnosis is a stark reflection of a severe crisis facing women in Kisumu:

the crippling, and often fatal, delay between noticing the first symptom and receiving definitive care. Though Milka, a 25-year-old from Kindubay, first noticed a progressive lump on her left breast in 2014, it took until January 2025 at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) to receive the diagnosis she had long suspected.

Ms. Omolo is one of 77 beneficiaries of the Kisumu Breast Cancer Project, a collaboration between JOOTRH, the Africa Cancer Foundation, and the Tiba Foundation, designed to reduce diagnostic delays and align with the WHO goal of timely diagnosis within 60 days. While this project has successfully created an express lane for initial diagnosis, the battle against time is being lost long before patients even reach the hospital doors.

The Community Bottleneck Threatens Progress

The core finding of the project’s interim report is devastating. community awareness is the missing link that could save hundreds of lives. Patients reported waiting a median of eight months after noticing symptoms before seeking a definitive diagnosis at JOOTRH. This prolonged delay ensures that a staggering

75% to 80% of patients are diagnosed at advanced Stage III or IV, where treatment options are limited and survival rates are significantly lower.

The severity of the problem is reflected in patient outcomes, with a concerning 20% mortality rate among the enrolled women within the first six months of follow-up. “At JOOTRH, breast cancer is the leading cause of death as far as cancers are concerned,” explained Dr. Albert Ng’onga, noting that this high death rate is a direct consequence of patients presenting so late.

Many women, particularly those from rural areas, delay seeking care because they do not recognize their symptoms—like a lump or breast pain—as cancer, or they mistakenly believe the disease only manifests as the debilitating, end-stage picture they have witnessed in their community. Furthermore, many patients navigate a confusing healthcare system, visiting an average of four before reaching a definitive diagnosis at JOOTRH, wasting crucial time.

The Kisumu project achieved a monumental success in eliminating initial hospital-level barriers. By subsidizing core biopsy procedures and having trained personnel on-site, the time from a patient’s first contact to receiving the core biopsy was cut to be nearly instant—a same-day biopsy was often achieved, with 100% of enrolled patients receiving the procedure within the two-day target.

“The ability to perform a core biopsy, which is often a financial barrier, and do it almost immediately upon presentation is a major victory for accessibility in this region,” said Dr. Ng’onga, emphasizing that dedicated effort and subsidized services successfully eliminated financial and logistical barriers at the hospital level.

However, the diagnostic process still faces a critical challenge at the hospital level: the time it takes for histopathology results to be processed at the JOOTRH laboratory. This crucial analysis of the biopsy sample averaged 19 days , with less than 10% of results meeting the ambitious 10-day target, delaying treatment initiation. This delay is mainly attributed to the insufficient human resources serving the lab.

Beyond the systemic delays, financial hurdles continue to deepen the crisis. Despite the fact that 94.7% of patients had government insurance (SHA/SHIF), 75% still cited financial constraints as a major barrier. Essential diagnostics, including histopathology, crucial Immunohistochemistry (IHC) testing, and staging CT scans—which cost approximately Ksh 50,000 in total—are often not comprehensively covered by the current insurance scheme, forcing patients to pay high out-of-pocket costs.

Moving forward, the project is tackling these problems head-on. The JOOTRH histopathology laboratory management is working to address the insufficient human resources to reduce the 19-day average turnaround time. More critically, the project is scaling up

Targeted community awareness campaigns will address the worrying eight-month pre-hospital delay and is teaching women about self-examination and early healthcare-seeking behaviors. As part of this outreach, the Africa Cancer Foundation is helping mobilize women for free breast cancer screening every Tuesday and Friday at JOOTRH, offering free mammograms and diagnostics for those at high risk.

The initiative demonstrates that while targeted projects can quickly solve access and initial procedure delays, lasting improvements in cancer survival demand systemic changes in laboratory capacity, dedicated insurance policy advocacy, and most importantly,

As Ms. Omolo wisely urged, “Please do not ignore any discomfort on the breast, whether you are young or old,” a message that must become the immediate call to action for every woman in Kisumu.