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BEYOND EARLY DETECTION: WHAT HAPPENS AFTER A BREAST CANCER DIAGNOSIS? 

  Breast cancer awareness must go beyond pink ribbons, screening campaigns and calls for early detection. Ghana must also confront whether its health system is adequately prepared to care for those who receive a diagnosis. Every October, pink ribbons, awareness campaigns and screening activities remind us of the importance of early detection in the fight against breast cancer. Across workplaces, churches, communities and health facilities, women are encouraged to examine their breasts, attend screening programmes and seek medical attention when they notice unusual changes. These messages are important. Early detection can improve treatment outcomes and save lives. But after losing someone I cared deeply about to breast cancer, I have found myself reflecting on a question that deserves equal attention: What happens after early detection? Let me call her Abena. Abena was a woman in her late thirties, a working professional who had spent more than a decade advocating for breast cancer awareness. She organised screening activities within her church and workplace and encouraged other women to take their breast health seriously. She understood the importance of early detection and actively promoted it. In August 2023, she discovered a lump in her armpit. An initial ultrasound examination reportedly indicated that the finding was benign. However, the swelling persisted, and a month later she noticed changes in her left breast. Further investigations, including biopsy, eventually confirmed breast cancer in November 2023. What followed was a difficult journey through the healthcare system. The physician who requested the investigations had travelled outside the country by the time the results became available. Abena was asked to wait until the physician returned before a referral could be made to the next level of care. Eventually, a colleague facilitated the referral. At the oncology unit, she was informed that the workload was high and that an arrangement described to her as "intramural" payment could secure an earlier appointment. Without this payment, her first appointment would have been in February 2024. She paid and was seen that same day. Subsequent review visits also involved additional payments.   The financial demands did not end with securing appointments. Each chemotherapy session cost approximately GH¢2,000, while a supportive injection administered after each session cost about GH¢900 at the time. The medication was provided for administration by health workers at a nearby facility. Abena completed eight cycles of chemotherapy and was preparing for a total mastectomy. Throughout this period, her health deteriorated. She experienced significant complications, including loss of sight and speech, and eventually died in June 2024. Yet, even while battling the illness, she managed to complete her Master of Laws programme. Her determination to keep going remains one of the things I remember most about her. I share Abena's story not to suggest that every aspect of her care was inappropriate or that one experience represents the entire health system. Neither can I establish that the challenges she encountered alone determined the outcome of her illness. However, her experience raises difficult questions about access, affordability, referral coordination and the support available to patients navigating serious illnesses in Ghana. A diagnosis should mark the beginning of a coordinated response, not the beginning of another struggle to find care. BEYOND AWARENESS: EXAMINING THE HEALTH SYSTEM  Early detection is only one part of the cancer care pathway. Following a suspicious finding, patients need timely diagnostic investigations, clear communication of results, appropriate referral, specialist consultation, treatment and continuous follow-up. These services must work together. Delays at any point can create additional anxiety, financial pressure and uncertainty for patients. This is particularly important when viewed against Ghana's commitment to achieving Universal Health Coverage (UHC) by 2030. The Sustainable Development Goals, especially SDG 3, call on countries to ensure healthy lives and promote well-being for all ages. Target 3.8 specifically commits countries to universal health coverage, including access to quality essential healthcare services, affordable medicines and financial risk protection. These commitments must translate into meaningful experiences for people who seek care. Universal health coverage cannot be measured simply by the number of people who enter a health facility or the availability of screening services. It must also be reflected in whether patients receive the right diagnosis at the right time, whether referrals lead to actual access to care, whether treatment is affordable and whether continuity of care is assured. The question is not only whether we can detect diseases early, but whether our health system is prepared to respond effectively when we do. Patient navigation is one area that deserves greater attention in strengthening cancer care. Nurse navigators play an important role in helping patients move through what can be a complex and overwhelming healthcare pathway. They support coordination of appointments and referrals, facilitate communication between patients and healthcare providers, help identify financial and psychosocial barriers and promote continuity throughout treatment. Ghana has made efforts to introduce and strengthen patient navigation services. However, we must look beyond the existence of individual initiatives and ask questions about their reach and sustainability. How many breast cancer nurse navigators are available across the country? How many have undergone structured, competency-based training in patient navigation? Are these services accessible to patients outside the major tertiary hospitals? Do we have adequate systems for their deployment, supervision and continued professional development? A patient navigator should not merely direct a patient from one department to another. The role requires the knowledge and skills to coordinate care, anticipate barriers and help ensure that patients are not lost along the treatment pathway. Strengthening this service should therefore form part of our broader investment in cancer care. The challenges highlighted by Abena's experience are also not exclusive to cancer. Patients living with hypertension, diabetes, stroke, kidney disease and other chronic conditions face similar needs for timely diagnosis, appropriate referral, affordable medicines, regular monitoring and continuity of care. As the burden of non-communicable diseases continues to increase, the demands on our health system will become even greater. This is therefore a broader health-system concern. We need to examine how effectively our services are organised to support patients from the point of first contact through diagnosis, treatment, rehabilitation and follow-up. The ability to provide continuous, coordinated and person-centered care must become a central measure of the quality of our healthcare delivery. TURNING POLICY COMMITMENTS INTO PATIENT EXPERIENCES  Ghana's Free Primary Healthcare initiative presents an opportunity to strengthen access to essential services, improve early identification of health conditions and reduce barriers at the primary healthcare level. Similarly, the Ghana Medical Trust Fund offers an opportunity to address some of the financial challenges associated with serious and chronic illnesses. These are important interventions, but their impact will depend on how effectively they connect with the wider health system. Expanding access to primary healthcare must be accompanied by adequate diagnostic capacity, functional referral systems, specialist services, essential medicines and a health workforce equipped to provide quality care. Financial support must also translate into access to the actual services patients need and when they need them. We must be careful not to create a situation where patients are encouraged to seek early care but encounter delays, prohibitive costs or limited treatment options once a serious diagnosis is confirmed. Access to healthcare should not end at the point of screening or diagnosis. It must extend throughout the patient's journey. This also calls for deliberate investment in the health workforce. Nurses and midwives are central to patient education, early identification, care coordination, treatment support and follow-up. Their capacity must be strengthened through appropriate training, adequate staffing, supportive working environments and the resources required to deliver quality care. Patient navigation, for instance, should not depend solely on isolated projects or the commitment of a few individuals. It should be deliberately integrated into the organisation of cancer services. BEYOND OCTOBER: A CALL FOR NATIONAL REFLECTION  Breast cancer awareness should not end when October ends. Screening campaigns and public education remain essential, but they must be matched by a health system that can respond to the needs of those who receive a diagnosis. Abena's story is a reminder that behind every diagnosis is a mother, a family and a future that may depend on how effectively the health system responds. It is also a reminder that the success of our health policies should ultimately be judged by the experiences and outcomes of the people they are intended to serve. As a country working towards UHC by 2030, we must move beyond counting the number of people screened, educated or reached through awareness campaigns. We must also ask whether those who need further investigations can access them promptly, whether referrals are completed, whether treatment is affordable and whether patients receive the support required to complete their care. This reflection is in honour of Abena and the souls our health system might have failed. Their stories should challenge us to look beyond awareness and confront the gaps that patients encounter when they need care the most. Early detection is important. But what happens afterwards is equally important. And so, beyond the pink ribbons, the screening campaigns and the annual calls for early detection, I leave us with one question: WHAT'S NEXT AFTER EARLY DETECTION?  I hope this question will spark a much-needed national conversation among policymakers, healthcare professionals, health institutions, civil society, communities and every Ghanaian who depends on the health system. We must collectively examine whether our healthcare delivery system is adequately prepared not only to detect illnesses, but also to provide timely, affordable, quality and continuous care to those who need it. Maame Akosua Serwaa Gyening Email: masagg30@gmail.com  

 

“Who knows what these children will become?” — Dr Kow Entsua-Mensah reflects on lives saved, hope restored and a new era of cardiac care
For more than 110 children, the first anniversary of the Ghana Medical Trust Fund (GMTF) is more than a milestone on the national calendar.
It represents something far more precious: the chance to live.
A chance to return home to their parents. A chance to play with their friends, walk into a classroom, learn a vocation, pursue a dream and grow into the men and women they were born to become.
That is the human story behind the numbers for Dr Kow Entsua-Mensah, Head of the National Cardiothoracic Centre at the Korle Bu Teaching Hospital, as he reflects on the first year of the Ghana Medical Trust Fund.
More than 150 patients who otherwise faced enormous financial barriers to lifesaving cardiac treatment are being taken care of at the National Cardiothoracic Centre alone. About 110 of them are children.
For Dr. Entsua-Mensah, those figures raise a sobering question: What would have happened to these patients if the Fund did not exist?
Behind every number, he said, is a human being whose future could easily have been cut short simply because a family could not afford the cost of lifesaving treatment.
110 children, 110 futures
It is the children whose stories appear to resonate most deeply with the cardiothoracic surgeon.
For families confronted with the diagnosis of a serious heart condition in a child, the battle is often fought on two fronts; against the disease itself and against the financial cost of treatment.
The intervention of the Ghana Medical Trust Fund is changing that reality for scores of families.
Dr. Entsua-Mensah looks beyond the operations and hospital beds to the futures now being reclaimed.
These children, he believes, “will grow stronger, play with their peers, return to school, pursue education and vocational training and eventually contribute to Ghana’s development”.
And then comes the question that perhaps captures the significance of the intervention better than statistics ever could:
Who knows what these children will become?
Among them could be Ghana’s future doctors, teachers, engineers, entrepreneurs, artists and national leaders.
Without treatment, some of those possibilities could have disappeared before they ever had the opportunity to unfold.
From a devastating fire to more than 60 lives saved
The impact of the Trust Fund at the National Cardiothoracic Centre goes beyond paying for patients’ treatment.
In 2025, fire ravaged the Centre’s cardiac catheterisation laboratory; a critical facility for diagnosing and treating complex heart conditions.
By the end of July 2026, the Ghana Medical Trust Fund had replaced the destroyed facility with a state-of-the-art cardiac catheterisation centre.
Since the new facility opened, more than 60 patients have undergone complex lifesaving procedures there, with many more patients lined up for treatment and emergency cases continuing to be managed.
During the Trust Fund’s initial 50-case pilot, designed to test its systems, 15 patients were sponsored to undergo lifesaving procedures at the National Cardiothoracic Centre.
Today, that intervention has expanded dramatically, with more than 150 patients onboarded for care at the Centre.
An investment in humanity
For Dr. Entsua-Mensah, the significance of the Ghana Medical Trust Fund cannot be measured only in cedis, equipment purchased or procedures performed.
It must also be measured in lives restored and hope returned to families.
“Adults whose illnesses had taken them away from their normal lives and livelihoods now have an opportunity to receive treatment and return to work. Children whose futures were threatened by serious heart conditions have an opportunity to grow and pursue their aspirations”, he added.
He describes the intervention as “a great investment in humanity”, an investment in the restoration of lives and, importantly, the restoration of hope.
Perhaps one of the Trust Fund’s most significant achievements, he observed, is the renewed confidence it is creating among ordinary families. The assurance that falling seriously ill does not necessarily mean a patient’s survival must depend solely on how much money that patient or family can raise.
Through the Ghana Medical Trust Fund, he said, people can increasingly have confidence that the state has an instrument through which it can come to their aid when they face critical illness.
Taking lifesaving heart care closer to Ghanaians
The transformation Dr. Entsua-Mensah sees is not confined to Korle Bu.
He pointed to the development of cardiology centres at the Komfo Anokye Teaching Hospital in Kumasi and Tamale Teaching Hospital as another important part of the emerging national cardiac-care network.
For decades, patients with complex cardiac conditions have had to travel considerable distances to Accra for specialised treatment at the National Cardiothoracic Centre.
The expansion of specialist cardiac infrastructure promises to change that.
Dr. Entsua-Mensah said the National Cardiothoracic Centre would be able to collaborate with its counterparts in Kumasi and Tamale, mentor and train professionals there and extend specialist services beyond Accra.
Ultimately, patients from those parts of the country would no longer necessarily have to travel to the capital for treatment.
Lifesaving cardiac care, he said, is being brought closer to the people.
And he believes Kumasi and Tamale could only be the beginning, with specialist services eventually extending to other parts of Ghana.
A dream beginning to unfold
One year into the existence of the Ghana Medical Trust Fund, Dr Entsua-Mensah believes something long imagined within Ghana’s specialist healthcare system is finally beginning to take shape.
“For the first time, what we have dreamt of, what we had hoped for is beginning to unfold right before our eyes.”
But perhaps the most compelling evidence of that unfolding dream will not be found in buildings, machines or statistics.
It will be found in a child returning to school after heart surgery.
In parents who once feared they might lose their child but can now watch that child run and play again.
In an adult returning to work after illness threatened a family’s livelihood.
And in the more than 110 children currently being given something no amount of money can truly measure, another chance at life and the opportunity to become whatever their dreams allow them to be.

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