Abstract
To the Editor,
Breast cancer is the most common cancer among Nigerian women, and in Nigeria, most patients fund their care via out-of-pocket (OOP) payments. In a recent prospective study at a tertiary hospital in South-West Nigeria, the mean cost of breast cancer care was USD 5192.77, while over 70% of patients experienced catastrophic health expenditure (CHE), with 66% lacking any health insurance coverage. 1 This stark financial toxicity disproportionately affects those who present with advanced disease, as late-stage treatment is more complex, lengthy, and costly.
The current health financing model in Nigeria is poorly equipped to absorb the financial burden of cancer. OOP expenses account for a significant portion of healthcare spending, while health insurance coverage remains extremely limited. 2 A retrospective analysis revealed that among 352 uninsured breast cancer patients at a private cancer centre, 74% risked financial catastrophe, and only 30% completed treatment. 3
Public policy must urgently address these gaps. First, health financing reform is essential: breast cancer care should be explicitly integrated into the national health insurance benefit package, including diagnostics, surgery, systemic therapy, and radiotherapy.
Second, investment in oncology infrastructure in Nigeria is long overdue. Radiotherapy and specialist cancer services remain concentrated in a few tertiary hospitals, forcing many patients to travel long distances for care. According to the National Cancer Control Programme, the six federal Oncology Centres of Excellence are currently undergoing phased upgrades, yet only four are fully operational at present. 4 Supporting regulatory data from the Nigerian Nuclear Regulatory Authority further highlights the severity of the gap: though approximately 14 radiotherapy-capable centres exist nationwide, only six hold valid licences, with several facilities either intermittently functional, operating below safety standards, or completely out of service due to equipment breakdowns. 5 This discrepancy between the number of centres that technically “exist” and those that are licensed, safe, and reliably functional underscores the urgent need to strengthen and geographically expand radiotherapy infrastructure. Establishing additional well-equipped regional cancer centres would reduce travel-related financial burdens, shorten care timelines, and improve timely access to life-saving cancer treatment.
Third, regulation and procurement policies should be used to reduce the cost of care. Centralized procurement, pooled drug purchasing, and pricing regulation on key cancer medicines can improve affordability. Additionally, standardizing diagnostic and treatment pathways can reduce excessive cost variation across facilities.
Fourth, early detection policies will not only improve clinical outcomes but also reduce financial burden. Integrating breast cancer screening (eg, clinical breast exam) into primary health care, training primary care workers, and launching community education campaigns can help shift diagnosis to earlier, more treatable (and less expensive) stages.
Finally, strong governance and political will are critical. Policymakers must legislate and allocate dedicated funds for cancer control, coordinate multisectoral efforts (health, finance, social welfare), and put in place data systems to monitor costs, outcomes, and financial hardship. Research such as the prospective cost study and analyses of insurance coverage should inform policy design, while periodic evaluation ensures accountability.
Breast cancer in Nigeria is not solely a clinical problem; it is a socio-economic challenge that demands urgent and comprehensive public policy intervention. By strengthening health financing mechanisms, decentralizing services, regulating costs, providing social protection, and prioritizing early detection, the Nigerian government can significantly reduce the financial toxicity associated with breast cancer, improve treatment adherence, and ultimately save lives.
