Abstract
D.Tech (Radiography)
Breast cancer is the most common cancer in women and the leading cause of global cancer-related female mortality. To control the mortality and socio-economic effects thereof, the World Health Organisation promotes early detection and diagnosis of the disease. Patients diagnosed at an early stage have a five-year survival rate of more than 80%, in contrast to less than 40% in those diagnosed at an advanced stage. In 2012, the South African breast cancer incidence was 9 815 with approximately a third thereof resulting in death. At the Chris Hani Baragwanath Hospital Breast Clinic in Soweto, a public sector hospital, 54% of patients presents with stages III and IV breast cancer. Reasons for this late stage presentation may include lack of education pertaining to breast health matters, cultural beliefs, support of traditional healers rather than westernised health care, the hierarchal referral system in the public sector, vast distances to travel to health care centres, high relative transport costs, the lack of early detection programmes and an insufficient staffing infrastructure.
Currently, 925 radiologists serve the population of almost 55 million, with an approximate public radiologist:population ratio of 4 per million population versus an approximate private radiologist:population ratio of 83 per million. In Australia, 59 radiologists are available per million population and in Canada the adequate ratio is recommended to be 77 radiologists per million population. Whereas one cannot directly relate the insufficient number of radiologists in the South African public sector to the advanced stage with which breast cancer patients present, one would be naïve to accept that the severe shortage of radiological expertise does not at all impact on the availability of medical imaging services and the early detection of breast cancer and that public sector patients have the same access to breast imaging services as private sector patients.
This thesis aimed at bridging the gap between too few radiologists in the public sector and equitable opportunities for the whole South African population to obtain...