Referral Pathways: Waiting. Waiting. Waiting…


A referral pathway is the path a patient has to walk, step by step, in the process of moving through breast cancer. It is intended to ensure that the outcomes of diagnosis and treatment are as proactive and positive an experience for the patient as possible. The referral pathway is also set in place to secure service equality at all levels.

PUBLIC SECTOR: In the public sector this normally means that a patient will start their journey at a primary health care facility in the community from where the patient is referred (via a letter of referral) by a health professional for follow-up to a Secondary Hospital. Once a diagnois is made by doing a mammogram, ultrasound and a biopsy, a patient will then be referred to a  Tertiary Hospital where the ‘staging’ of the illness will be done via additional tests such as a lung X-ray, liver scan and  bone density test. These tests will help develop the appropriate treatment plan if applicable.

STATE SECTOR: Things are, however, different in South Africa’s state sector where the same process as above can literally take entire months to be processes. Result? By the time the patient reaches the tertiary hospital, the illness has progressed to a later stage.

referral pathways breast cancer advocates for breast cancer


We are privileged to have a few truly effective walk-in breast clinics in our country – such as the ones at Cape Town’s Groote Schuur Hospital and at Johannesburg General Hospital where patients can go straight to the specialised breast clinic, where all the above-outlined steps are done in a very efficient manner. We need many more of these cancer screening clinics that will expedite prompt diagnosis and work-up to ensure that effective treatment is provided — sooner rather than too late!


“Stage at Breast Cancer Diagnosis & Distance from Diagnostic Hospital in a Periurban Setting: a South African Public Hospital Case Series of Over 1000 Women.” ~ via the National Centre for Biotechnology Information


Compared to the state sector, the private sector’s referral pathway is markedly simpler and shorter, making access to breast cancer diagnosis and treatment easier and more efficient. Your journey could look like this:



Day -4 Referred by GP
Day 0 Seen in clinic. Assessment by surgical team, X-Ray and histopathologist
Day 1 The Multi Disciplinary Team (MDT) co-ordinator collates the information on all patients who have abnormal results from the clinic – then guides and drives the rest of the pathway communication regularly with the patient and the rest of the team
Day 3-7 Discussion at the MDT meeting: the whole team meets to discuss the results for patients and concur on a patient treatment plan. (Treatment plans vary from patient to patient.)
Day 9+ Pre-operative assessment with pre-assessment nurse and the breast care nurse if mastectomy is necessary.

Pre-planning for radiotherapy if adjuvant therapy is applicable

Pre-planning with oncologist for chemotherapy if adjuvant therapy is applicable

Day 14 Surgery/chemo therapy/radiation therapy starts and continues as required for breast cancer standardised treatment guidelines.
Day 15+ Discharge if operated
Day 17+ Re-discussion at MDT meeting to plan further treatment if necessary after surgery
Day 18 – 21+ Seen at clinic with final and full results of surgery
Next Phase Start of further therapy

Hormone therapy



Follow-up with Oncologist Usually 6 – 12 months for up to 5 years



In the absence of a breast health policy in South Africa, the time linked to a referral pathway is dependant on where you live, how soon you can be referred to the facility which will then confirm the diagnosis and the actual waiting times between screening, diagnosis and ultimately, treatment.


The driving aim of a BREAST HEALTH POLICY is to ensure that each and every single person in our country has equitable and accessible access to effective and efficient breast health services.  This is a basic health right! It is a right we all havedeserve and must insist on as South African citizens and human beings!

Make the difference only YOU can make by Liking our Facebook page or joining this critical conversation on Twitter! Share our FB posts and email off our blog articles to those you know care! This is how you can stand with us to adamantly ensure this policy is drafted and implemented timeously to save the lives of thousands of women in South Africa!


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