The Journey of a Woman with Breast Cancer in Coastal Kenya

October is Breast Cancer Awareness Month, a time when the world turns pink, when cities light up in solidarity, and when women are urged to check their breasts, talk to their doctors, and celebrate survivors. But on the quiet island of Pate, off the northern coast of Kenya, far from the noise of the city or the glow of pink ribbons, the reality of breast cancer feels painfully distant and painfully different.

When our speed boat cut across the turquoise waters of the Indian Ocean towards Faza village in Pate Island, I could see why many describe it as one of Kenya’s forgotten paradises. Coconut palms lined the shore, beautiful sunsets, and the call to prayer echoed from a small mosque nestled between crumbling coral-stone homes. Yet beneath that beauty lay a harsh truth.

Pate Island, part of Lamu County, is home to roughly 100,000 people, many living in meager to modest conditions and relying on fishing or small-scale trade. Because of its proximity to Somalia, the area has faced security threats from Al-Shabaab, cutting it off from tourism and development. For healthcare, isolation is a way of life. The only way in or out is by boat.

This October, I joined a team from the GREAT Project — a group of medical professionals working to raise awareness about breast cancer in marginalised communities in collaboration with local partners. We set out to teach women how to perform self-breast examinations (SBE), offer ultrasound screening, and refer cases to hospitals for follow-up.

But what we discovered was far more sobering than we imagined.

Faza Village

A Hidden Burden

When we gathered the women from three villages where we held our camps, over a hundred women came. Some held babies, others wore brightly colored kangas wrapped tightly around them, their faces a mix of curiosity and quiet apprehension. As we began to talk about breast cancer — what it is, how to check for it — our team asked how many had ever done a breast self-exam. Out of more than 100 women, only a handful had ever checked their own breasts or been taught how to. It was the same story with the community health volunteers who assist in the local clinics — willing and dedicated, but with no training or tools for breast cancer awareness.

Kenya’s national data reflect this disparity. Breast cancer is now the most common cancer among women in the country, accounting for 16% of all new cancer cases. Yet behind those numbers are women like the ones sitting before me — women whose greatest barrier isn’t biology, but geography and inequality.

In Kenya, nearly 40% of breast cancer cases are detected at Stage III/ IV, when treatment is most difficult and survival chances are slim. In high-income countries, early detection means survival rates of 80% or more. Here, in many rural counties, survival is less than half that. Additionally stats from Kilifi county sub-county hospital reveal that the majority of these new cases are women between 40-50years of age. More and more younger women are getting cancer without an understanding as to the reason why.

The Long Road to Diagnosis and Treatment

For a woman in Faza village who feels a lump, the journey ahead is almost impossible. The first stop is the Faza Sub-County Level 4 Hospital, the island’s main facility. If the doctor suspects cancer, she is referred to Lamu County Hospital on the mainland — a journey of 3–4 hours by wooden boat, or one hour by speedboat if she can afford the fare.

Once there, she must pay for tests that health insurance doesn’t cover. As Dr. Suchira Udugamasooriya, Clinical Oncologist specialist at Kilifi County Hospital, explained, even a simple biopsy gun can cost about 3,000 Kenyan shillings — money most families here simply do not have.

If the biopsy confirms cancer, the woman must travel again — this time to Mombasa, six to seven hours hours away by road, through multiple military checkpoints because of security threats in the region. After days of travel across sea and land, she finally arrives at Coast General Teaching and Referral Hospital, one of the few facilities offering radiotherapy in the entire coastal region. But even then, her ordeal is far from over.

“There’s usually an eight-week waiting period just to start radiotherapy,” said Dr. Fatma Amoody, the hospital’s clinical oncologist and regional representative for the National Cancer Institute. “Many of our patients come from distant places like Lamu or Tana River. They have nowhere to stay, so they sleep in hospital corridors or outside.”

And though Kenya’s health insurance scheme — now under the Social Health Authority (SHA) — covers part of the cost, it pays for around three rounds of chemotherapy. After that, treatment is out-of-pocket.

The Choice No Woman Should Have to Make

As I sat with the women after the screenings, one of them leaned towards me and whispered, “Daktari, most of us would rather not know. Because if it’s cancer, it’s already a death sentence.” Her words lingered long after we left the island.

For her, and for so many others, the fear of knowing is not irrational — it is survival. Knowing means facing a medical system that is distant, expensive, and slow. It means borrowing money, selling land, or watching her children go hungry to pay for treatment. It means traveling across dangerous waters for care that might come too late.

A Call for Equity

This year’s United Nations General Assembly (UNGA) debated on noncommunicable diseases (NCDs) in New York. World leaders spoke passionately about shifting to community-centred care — where prevention, early detection, and treatment begin at the grassroots level. The UN Political Declaration on NCDs reaffirmed that without empowering communities, universal health coverage will remain an aspiration rather than a reality.

What I witnessed in Faza is precisely what those global conversations were about: how policies shaped in distant halls translate — or fail to translate — into the lives of women in rural communities. Emphasis on decentralised screening, community health worker training, and financing models that remove out-of-pocket costs are all crucial to saving lives in places like coastal Kenya and other Low and Middle income countries.

From Awareness to Action

Awareness without access changes little. In Kenya, as across much of sub-Saharan Africa, we need to move from symbolic awareness to systemic inclusion:

1. Equip county hospitals with diagnostic tools and trained personnel (with a lense on gender specifically when working in marginalised communities).

2. Empower community health volunteers to deliver accurate cancer education and support.

3. Fully cover diagnostics and treatment under the national insurance scheme.

4. Build safe transport and accommodation pathways for rural patients traveling long distances.

As global leaders continue to champion health equity, Faza reminds us that the battle against NCDs will not be won in conference rooms alone ,it will be won in communities, by women who choose to face their fear, and by systems that choose to meet them halfway.

The promise of UNGA must reach them — not someday, but now.

This mission was supported by GREAT Project