Costly battle: Bills, stockouts and delays deepen breast cancer burden

Charity Kanyi, breast cancer survivor. [Rosa Agutu, Standard]

In July 2019, when then 51-year-old Charity Kanyi walked out of the operating room after a mastectomy to remove her right breast, she was not aware of the long-term financial burden that would follow.

Diagnosed with stage one breast cancer in May 2019, she initially struggled to believe the news because no one in her family had the disease. After three months of consultations and tests, she began treatment.

After the mastectomy, she received eight chemotherapy sessions, visiting the hospital monthly.

“Radiotherapy was not recommended because the cancer had not crossed the surgical margins,” she says.

Her treatment was complicated by an underlying kidney condition, which required doctors to consider her health when planning care.

Although the then national health insurance NHIF covered part of her chemotherapy, she says she also paid out of pocket. She had her sessions at a private hospital.

“Chemotherapy was around Sh135,000 -Sh150,000 so NHIF covered between Sh50,000–Sh60,000 for only 3 sessions; the rest I paid cash,”

 In January 2021, she began oral medication prescribed for 10 years.

“I take Letrozole 2.5mg daily; one tablet is around Sh140. I buy the monthly dose out of pocket because of stockouts in hospitals; that is Sh4,200 per month.” Letrozole is used to treat hormone receptor-positive breast cancer.

Beyond medication, she spends money on an ointment to ease irritation around her surgical scar.

“Sometimes my arm is swollen; I have to go for physiotherapy; that’s another cost.” She says, “The scar is also another problem, especially when you remove the breast prosthesis; it becomes very sore, so I have to buy a cream to apply. I use two tubes per month.”

The cost of one tube is between Sh690 and Sh850.

The silicone breast costs her Sh25,000. ”You can use it for around 3 years before the cloth inside starts to wear off.”

Since most women cannot afford the silicone option, they opt for knitted ones.

She goes for nutrition visits every month. And an annual mammogram, kidney function and blood test.

Financially, she has relied on support from her children, family and friends.

She hopes survivors will be supported to encourage patients: “We need survivors to boost the morale of current cancer patients so that they know it is not a death sentence. Kindly request the government to facilitate these trainings in churches, hospitals, and schools.”

Dr Dulcie Wanda, Clinical and Radiation Oncology at Nakuru Regional Cancer Centre, says that after pathological diagnosis and before treatment, it is important to know whether the cancer is hormone-sensitive or non-hormone-sensitive.

Once they confirm it’s cancer, they offer counselling, discuss the results and then the next step would be to send the patient for a scan to get to know how far the cancer has spread.

“We do a CT scan of the chest, a CT scan of the abdomen, and also a CT scan of the pelvis, just to know how far the disease has gone,” says Dr Wanda.

Then send for lab work to know how the kidneys are working, how the liver is working, and the general picture of blood.

“So, there are certain markers on the tumour cells that are called receptors and some of them have oestrogen receptors ER, progesterone receptors PR, and some of them also have something called HER2,” says Dr Wanda.

Breast cancer patients in Kenya struggle with high treatment costs and limited insurance cover. [iStockphoto]

ER and PR are like locks on cancer cells, while oestrogen and progesterone act like keys that can activate signals influencing cell growth. When a cancer is hormone-receptor positive, doctors may use hormone therapy to block these effects or reduce hormone production.

HER2 works differently. It is a protein involved in sending growth signals to cells. Some breast cancers have too much HER2 protein or excessive HER2 signalling, causing the cells to grow more aggressively. Targeted medicines such as trastuzumab can block this signalling.

The results help doctors determine which treatments are most likely to work for each patient.

“Breast cancer has very many permutations in terms of treatment. If you have 10 women with breast cancer, they can be on totally different types of treatment based on stage, hormonal profile,” says Dr Wanda

Treatment includes surgery. There are times after looking at the tumour, they may decide that this patient needs to have chemotherapy first to shrink the tumour, then be able to now give other treatments.

“Then radiation uses rays or identical beams to treat the cancer. Remember, cancer happens when there's a DNA mutation in the cells. Radiation targets the DNA and causes breaks in the DNA, then that cell can die off because now there's an error in the DNA of that particular cell,” adds Dr Wanda

Dr Miriam Mutebi, an oncology surgeon, says tests help doctors establish whether surgery is appropriate and what procedure may be required.

If the disease has spread to other areas, then the role of surgery might be minimal.

“We also want to know what the patient's preference is, because one would also perhaps want to offer reconstruction at the time of surgery if one has to do a mastectomy,” she says

If the patient has advanced disease and it's in multiple areas, then surgery might not be a treatment option.

“When we offer breast conservation, which is what we call lumpectomy, that's removing the lump; it needs to be accompanied by radiotherapy. If you do a lumpectomy only and no radiotherapy, then the chances of the tumour coming back in the same place are almost 50%,” she adds

However, the cost of diagnostics and treatment can prohibit some patients from getting treatment early.

“Health insurance does make a difference in terms of whether sometimes a patient can navigate this process promptly. Certainly, social health insurance has helped in terms of covering some of the costs of diagnosis, and anyone who has coverage generally navigates the system with fewer delays.”

On the average cost of the surgery, Dr Mutebi says it differs from area to area, and also depends on the type of surgery and what needs to be done. “Certainly, all we can say is that the earlier the tumour is diagnosed, sometimes the less we do.”

Psychologist Philip Ouma, who specialises in psycho-oncology, says a breast cancer diagnosis often triggers shock and fear of death, although cancer is not necessarily a death sentence.

For women undergoing mastectomy, the removal of one or both breasts can trigger loss of femininity, body image and a part of their identity. “There's a sense of loss. So you're grieving. Grieving part of your beauty because breast is part of the beauty,”

He also highlights the psychological burden of treatment costs, insurance limitations and fundraising, which can leave patients navigating cancer treatment alongside financial distress and relationship challenges.

“Some patients abandon essential hormonal therapy after completing chemotherapy and radiation because they cannot afford continued care,”

Phoebe Ongadi, Executive Director of the Kenya Network of Cancer Organisations (KENCO), says the financial burden of breast cancer begins long before treatment, with women struggling to afford transport, imaging, biopsies and pathology tests needed to confirm a diagnosis.

Delays caused by financial constraints, long waiting periods and repeated referrals can allow the disease to progress, making treatment more difficult.

“Breast Cancer Awareness Month, we are saying we want awareness and access. Beyond medical bills, patients face hidden costs, including transport, accommodation, food, lost income and expenses incurred by caregivers accompanying them to hospital.”

These costs can force patients to delay treatment or abandon it midway.

She also advocates for stronger primary healthcare services, enabling lower-level hospitals to diagnose cancer conclusively and reducing costly referrals that delay treatment.

Beatrice Wangui Kairu, a Health Economist, says the financial burden extends beyond hospital bills. “Patients must pay for transport, accommodation, food and repeated hospital visits, while treatment may force them or their caregivers to stop working or lose income.

“Kenyan research published in 2018 estimated the cost of guideline-based treatment for stage I–III breast cancer at approximately US$1,340–US$1,543 in public facilities, with substantially higher costs in private facilities,” says Kairu

A 2026 study of 103 breast cancer patients at Kenyatta National Hospital published by ASCO Publications estimated average total costs at Sh2.14 million per patient.

Of this amount, approximately Sh1.34 million was direct medical expenditure, Sh288,000 covered direct non-medical expenses, and Sh513,000 represented indirect costs, including income-related losses.

Targeted therapy accounted for 45.37 per cent of direct medical costs, while patients with stage IV and Luminal B disease incurred the highest total costs in the study. These estimates reflect specific studies and should not be treated as national averages.

In the 2026 study, 97 per cent of participants relied on personal income and savings, 29 per cent sold assets, and 22 per cent took loans.

Despite having used the former National Hospital Insurance Fund, now succeeded by the Social Health Authority (SHA), insurance reportedly covered only 25–50 per cent of direct medical costs.

Delays further compound the burden. A Kenyan study published by the National Library of Medicine involving 378 women receiving breast cancer care at Kenyatta National Hospital found a median 13-week interval between symptom onset and hospital presentation, followed by another 17.5 weeks from presentation to diagnosis and six weeks from diagnosis to initial intervention.

Kairu recommends strengthening early diagnosis, pathology services and referral systems; negotiating affordable medicine prices; improving procurement; and preventing medicine stockouts. She also calls for stronger financial protection through SHA.

“In May 2025, the Ministry of Health announced a partnership to reduce the cost of specified breast cancer treatment sessions from Sh120,000 to Sh40,000, a reduction of approximately 66.7 per cent, at participating facilities.

In November 2025, the Ministry announced that the cancer care package would increase from Sh550,000 to Sh800,000 from 1 December 2025.

In June 2026, the Ministry described a further increase in annual enhancement support for cancer patients through the Emergency, Chronic and Critical Illness Fund (ECCIF) support for chronic cancer care, from 150,000 to Sh400,000, as a proposed reform. Eligible patients could access up to Sh800,000 when combined with existing SHIF benefits.

In March 2025, the Ministry of Health (through the Social Health Authority, SHA) and Roche East Africa had a Memorandum of Understanding (MoU) capping breast cancer treatment sessions (For HER2+ therapies like Herceptin) at Sh40,000 from Sh120,000 with no co-payment for patients.

Private health insurance can help patients meet some of the costs of cancer care, but the extent of protection depends on the policy, benefit limits, exclusions and conditions attached to claims.

Britam says its Milele Health Plan covers breast cancer under the inpatient benefit, subject to the policy’s chronic and pre-existing condition sub-limit. For individual, retail and small and medium-sized enterprise clients, inpatient cancer care has a 12-month waiting period. Surgery, theatre, intensive care, chemotherapy, radiotherapy and take-home medication for up to 30 days fall within the inpatient limit and require pre-authorisation.

Diagnostic procedures, including biopsies, histopathology and immunohistochemistry (IHC) tests, are covered under the outpatient limit. Outpatient care for pre-existing chronic conditions has a 30-day waiting period and does not require pre-authorisation. Corporate clients have no waiting periods for inpatient or outpatient cover, according to Britam.

The amount covered depends on the plan and inpatient limit. At the Sh10 million inpatient tier, the chronic and pre-existing condition sub-limit is Sh1.2 million for Platinum, Sh1 million for Gold and Sh800,000 for Silver. Platinum members on lower inpatient tiers may have a sub-limit of just Sh150,000.

Milele also offers a cancer-inclusive critical illness cash benefit, subject to a 24-month waiting period. It pays a lump sum of up to Sh750,000 for Platinum, Sh700,000 for Gold and Sh600,000 for Silver, available only on the Sh5 million and Sh10 million tiers.

Britam says approved targeted medicines such as Herceptin are covered within the applicable sub-limit. However, patients remain responsible for costs exceeding their limits, excluded items and co-payments.

Claims may be delayed or declined because of unserved waiting periods, missing pre-authorisation, incomplete documentation, excluded treatment or exhausted benefits.

 

Utilities

Breast Cancer Statistics by National Cancer Institute of Kenya

Approximately 6,799 women are diagnosed annually

About 3,107 deaths per year.

Around 70% to 80% of breast cancer patients in Kenya are diagnosed at advanced stages (Stage 3 or 4)

Cost of treatment published by ASCO Publications

Sh2.14 million — estimated average total cost per breast cancer patient in a 2026 study involving 103 patients at Kenyatta National Hospital.

Sh1.34 million — direct medical costs per patient in the study.

Sh288,000 — direct non-medical costs, including expenses such as transport and accommodation.

Sh513,000 — indirect costs, including financial losses associated with illness and treatment.

45.37% — share of direct medical costs attributed to targeted therapy in the study.

97% — patients who relied on personal income or savings.

29% — patients who sold assets to finance care.

22% — patients who took loans to meet treatment costs.

Delays in diagnosis and treatment published by the National Library of Medicine

A study involving 378 women receiving breast cancer care at Kenyatta National Hospital reported:

13 weeks — median time from noticing symptoms to presenting at hospital.

17.5 weeks — median time from hospital presentation to diagnosis.

6 weeks — median time from diagnosis to initial treatment.