SA’s CANCER STORY (Part 3): Amid many challenges there are also ‘major wins’ — the case of cervical cancer

On 1 October, a jubilant mood reigned at the unveiling of the new Pfukani Mobile Clinic in Bushbuckridge, Mpumalanga, with cancer advocates, local residents, health workers and traditional leaders crammed into a community hall.

Obstetrician gynaecologists Dr Vincent Shongwe and Dr Martin Namane, who will staff the bright pink-emblazoned truck, were also present. Among other services, Shongwe and Namane will perform pioneering hour-turnaround tests to screen for the cervical cancer-causing human papillomavirus (HPV). Should they pick up a high-risk HPV strain, particularly 16 and 18, they can immediately inspect a patient’s cervix with same-day treatment available for precancerous cervical lesions.

On the shoulders of a giant cervical cancer-fighting legacy 

Inside the mobile clinic, the tests will be done on a GeneXpert machine (primarily used for tuberculosis screening). The late Professor Lynette Denny helped develop and validate the HPV test for the GeneXpert platform in Khayelitsha, Cape Town, about a decade ago.

It was Denny’s dream for the hyper-efficient HPV “test and treat” technology to be widely rolled out across South Africa. While this ambition is still in the making (the Department of Health’s 2026 framework for eliminating cervical cancer lists “single-visit test and treat” technology under “future interventions”), the Pfukani Mobile Clinic is a step in the direction Denny was advocating for. The R2-million facility is a public-private partnership between the Mpumalanga Department of Health and Discovery Health.

Shongwe tells Spotlight and Daily Maverick that he was born at Mabuleng Hospital, 2km down the road. “I like to give back, I know what a big problem cervical cancer is in this region,” he says. “I have had someone in my family who died from cervical cancer. And my mom had a malignant lesion but she was treated, and she’s fine. This influenced my decision to become a gynaecologist, but it was my passion even before.”

With cervical cancer every day matters

With cervical cancer every day matters, says Shongwe, “getting the procedure done as soon as possible is best”. He is referring to thermal ablation, when controlled heat is used to destroy abnormal, precancerous cells on the surface of the cervix; or “large loop excisions of the transformation zone”, where a thin wire loop is used to cut away a small piece of the cervix containing precancerous cells.

Discussing the impact of the rapid-screening tests, he says regular HPV test results from a state laboratory could take up to 12 weeks. “We lose some patients,” he says. “They don’t come back for the results. Even if they do, then it can take up to two to three months for their procedure [thermal ablation or large loop excisions] because of bottlenecks. So this quick test [and same-day treatment with these procedures] will really, really make a difference.”

Inside the 2m-by-4m clinic’s separate cubicle for clinical examinations, Namane points out their treatment bed and equipment. He explains that HPV testing is different to conventional “pap smears” in that it requires a shallow vaginal swab instead of a deep scraping of the cervix. This means women can swab themselves (“self sampling”) should they choose to, he says.

A public-private partnership

Later, cutting a pink ribbon to loud cheers, provincial health MEC Sasekani Manzini officially opens the mobile clinic, which will rotate around the area and treat about 20 patients a day. Addressing the crowd, she says: “We are grateful for this meaningful gesture... public-private partnerships are crucial in accelerating service delivery and ensuring that no one is left behind.”

Manzini encourages women across Mpumalanga to embrace Cheka Impilo (“check your health”) and to prioritise regular screenings – even without symptoms – because early detection saves lives, she says.

Traditional healers and cancer

Meanwhile, the nonprofit Breast Health Foundation, the driving force behind the mobile clinic, has sought collaboration with traditional healers, providing them with training in cancer awareness. 

Speaking at the launch event inside the Maviljan community hall, Chantel Mokoena, a sangoma affiliated to traditional health collective Lesaka La Di Ngaka, says she supports the mobile clinic. “I’m very happy about it,” she says. “With cervical cancer, many people don’t even disclose it. As traditional healers, we want the same things as doctors and nurses, we want people who are healthy.”

In the area, historically tensions have simmered between nurses and traditional healers. “Sometimes when we refer patients to clinics, sometimes those nurses don’t take us seriously,” Mokoena says. “That’s the problem for us, these doctors and nurses need to treat us like colleagues.”

The national picture 

In Johannesburg, Spotlight and Daily Maverick meet Dr Nonhlanhla Ndlovu, the deputy director-general for HIV, Aids, TB and maternal-child health at the National Department of Health. Ndlovu reiterates that from 2024 HPV screening was introduced in public healthcare as an alternative to pap smears (in alignment with World Health Organization recommendations) since HPV screening detects infection before cellular abnormalities develop, allowing for earlier intervention.

She says that, among 928,811 South African women screened for HPV in the public sector in 2025, high-risk HPV strains were detected in 322,611 cases. She is visibly excited about self sampling and rapid HPV tests, saying these are “on the horizon”, but that currently the department cannot allocate budget for a nationwide roll-out.

It’s personal 

For Ndlovu, too, cervical cancer is personal. She says she lost an aunt, who was like an elder sister to her, to stage 3 cervical cancer. Another woman close to her family was diagnosed with stage 3 cervical cancer, despite having had pap smears. The problem is, Ndlovu says, that this family friend never even saw her pap smear results. The woman had chemotherapy and radiotherapy at Grey’s Hospital in Pietermaritzburg and now lives with Ndlovu in Pretoria. “For me, therefore it said the system is broken,” Ndlovu says. Wanting to help work towards a solution partially motivated her last year to assume her present position at the Department of Health.

According to a number of sources, cervical cancer is the second-most-common cancer in women in South Africa behind breast cancer. It is also the cancer that claims the second-most lives in the country, again behind breast cancer.

In South Africa in 2024, 5,165 women died of cervical cancer, according to the International Agency for Research on Cancer. Ndlovu insists the tragedy of this figure is that these deaths are largely preventable through early detection. Or HPV vaccines.

South Africa’s incredible HPV vaccine programme

South Africa launched its HPV vaccination programme in 2014 – a collaboration between the departments of Health and Basic Education – which today extends to include girls in public, private and independent schools, with about 3.6 million vaccinated. Health experts agree that the programme is a massive “win”.

Since cervical cancer typically develops quite slowly, it is still too early to see the impact of the HPV vaccination programme in South Africa’s cervical cancer statistics. But there is already good evidence that HPV rates are down. A landmark study on the matter found that HPV rates were 83% lower among a group of vaccine-eligible 17- and 18-year-old girls than it was in an earlier group of 17- and 18-year-old girls who were not eligible. Eligibility is stressed here since not all girls in the eligible group would have been vaccinated.

Presenting during a webinar on cervical cancer elimination, co-hosted by the Department of Health on 8 October, obstetrician gynaecologist Professor Helen Rees of the University of the Witwatersrand put South Africa’s current HPV vaccination coverage among the target group at 78%.

Commenting on herd immunity (indirect protection from an infectious disease when a large percentage of a population becomes immune), Ndlovu says: “The World Health Organization says if we reach 90% [coverage in the target group, in South Africa girls aged 9 to 15], we will reach herd immunity.” 

During the same webinar, gynaecological oncologist Professor Hennie Botha of Stellenbosch University described South Africa’s HPV vaccine programme as “a major win”.

“The vaccine has proved very efficient and cost effective,” he said. “We’ve made the best choice for South Africa by introducing HPV vaccines into schools.”

To illustrate further anticipated success, Botha noted the UK’s national HPV vaccination programme, introduced in 2008. “You can see in a place like the United Kingdom, where they’ve been giving the vaccine now for almost two decades… for the first time now, there’s zero cervical cancers in very young women in England, women who were vaccinated. So that is excellent news. Vaccination will work,” he said.

Vaccinating boys?

He added that the programme ought to be expanded further into private schools – where parents have proved more hesitant to sign consent forms for their daughters to receive the HPV jab – and that officials need to consider vaccinating boys. Speaking to Spotlight and Daily Maverick, Ndlovu concurs: “If you really wanted to go all the way in terms of prevention of HPV, you would have to vaccinate both boys and girls. But we can’t at the moment from a cost perspective,” she says. Research has shown that HPV vaccination reduces the risk of anal cancer in boys and men.

Convening the webinar discussion, Thembi Zulu, deputy director of women’s health at the Department of Health, said: “And as parents it is vital that we sign those consent forms, and that we explain to other parents why it is important for their children to be vaccinated, how it prevents their children from having a deadly disease decades later.”

During the webinar, Grade 10 pupil Manala Makua offered a sobering perspective, that teenagers have a right to know what is being administered to them. “Among people I know, I think the general conversation about HPV is nonexistent,” she told the 3,000 webinar attendees. “When I first got the vaccine, I did not really understand what it was for. Many of us have heard about the vaccine but we do not understand what it does to our bodies. Talk to us. Not just about us.”

‘I wish they could see what I face’

Meanwhile, in Bushbuckridge, as fog rolls over the Mpumalanga escarpment, Shongwe says: “I’m just happy with government for starting this HPV vaccination programme. It’s a very, very important initiative. I understand though that people are scared of vaccinating. I wish they could see what I face in the hospital, seeing people dying from a cancer that can be detected early, that can be cured. I mean, seeing what I see as a doctor, it’s really upsetting.”

At the Pfukani Mobile Clinic, Shongwe certainly serves at the coalface of South Africa’s fight to prevent and better detect cervical cancer. 

“By integrating this unit into our provincial referral system, we ensure that every woman screened receives seamless, dignified care,” MEC Manzini says. “This strengthens our commitment to reaching communities where distance, cost and infrastructure have long limited access to early detection and treatment.” DM

This is the third of six articles in the series. Part 1 told the stories of two women who got breast cancer. Part 2 zoomed in on the numbers, and asked whether cancer cases are really going up in South Africa.

Disclosure: Discovery Health paid for Huisman’s travel to and accommodation in Mpumalanga.