Why I’ll wear black, not pink, for Breast Cancer Awareness Month

Every October, during Breast Cancer Awareness Month, we ask South Africans to wear pink. We celebrate survivors and walk for awareness.

This year, I will wear black.

Not because breast cancer has become deadlier, or because there is no progress worth celebrating. Not because I have lost hope. But because somewhere along the way we have lost our capacity to be outraged.

We have grown so accustomed to preventable suffering that stories which should provoke national soul-searching barely survive a single news cycle. A woman waits months for a biopsy. A hospital operates without functioning equipment. A patient with curable cancer becomes palliative while waiting for treatment. 

We shake our heads, and we move on.

That should terrify us.

As a breast cancer surgeon working across both our healthcare systems, I see these failures daily. Through Project Flamingo and the Cancer Alliance of South Africa, I see them nationally: in the past three months alone, I have fielded more than 200 urgent requests for help. These are not requests for a mere second opinion or preferential treatment. They arrive after every other door has closed.

Women waiting months for imaging. Biopsies disappearing into administrative voids. Families travel hundreds of kilometres for a single appointment. Women with curable cancers arrive with metastatic disease after months, or years, of navigating a system that repeatedly failed them.

None of this should surprise us. We have Auditor-General findings, Special Investigating Unit investigations and Health Ombud reports. Parliamentary hearings. Strategic frameworks. Provincial budgets documenting workforce and infrastructure pressures. We have reports upon reports telling us what is wrong.

We have known for years. The question is not whether we understand the problem, but why we tolerate it. The greatest threat to our healthcare system may be that we are becoming comfortable watching it fail.

I often wonder how different our public hospitals would look if every elected representative, senior health administrator and policymaker depended on them, with no private alternative. If their partners gave birth there, their parents waited there for oncology appointments and their children relied on those emergency departments. 

Would broken lifts stay broken? 

Would medicine shortages survive another budget cycle? 

Or would accountability suddenly become urgent?

Perhaps we will only understand when the patient is us, or someone we love. Must we all receive a cancer diagnosis before we care?

Cancer collapses the distance between the theoretical and the real. Mortality sits at the kitchen table. It inhabits the silence between a scan and its result. We forget this when we discuss healthcare in the language of budgets, vacancies and targets: there is a human being at the other end of every number.

And she is frightened.

There is an uncomfortable metaphor in the disease I spend my life treating. Cancer emerges when cells lose the restraints that allow the whole organism to survive; growth turns destructive and threatens the very body it depends on. Sometimes I wonder whether societies can fall ill in a similar way, when self-interest overwhelms collective responsibility, corruption consumes resources meant for the vulnerable, and institutions forget whom they exist to serve.

The 19th-century pathologist Rudolf Virchow put it plainly: “Medicine is a social science, and politics is nothing but medicine on a large scale.” If he was right, a health system that fails the poor is not only a clinical problem but a political illness, and awareness alone will not cure it.

This is not really about breast cancer. The women in our clinics carry far more than a diagnosis: poverty, violence, food insecurity and impossible choices. A society that fails to protect women before they fall ill should not be surprised when it struggles to care for them afterwards. Whether the subject is gender-based violence, corruption or delayed cancer treatment, the question is the same: when did preventable suffering become something we simply learnt to live with?

This is not an attack on public healthcare. It is a defence of it: of the principle that where you are born, what you earn or which medical aid card is in your wallet should never determine whether you receive timely, dignified cancer care. 

Nor is it a criticism of the healthcare workers holding the system together, who deserve systems that let them succeed. Asking a few good people to deliver extraordinary care inside normalised dysfunction is not resilience. It is institutional neglect. Moral injury and burnout are the norm and many have simply stopped trying because of sheer exhaustion.

Project Flamingo and the Cancer Alliance have spent years stepping into these gaps, funding surgeries, diagnostics and patient navigation. But we cannot keep treating the symptoms while ignoring the disease. South Africans have been promised reform across administrations, parties and provinces, yet patients’ experience tells a different story. Given that record, caution about the National Health Insurance plans is prudent.

Hope matters. But hope without accountability becomes consent for what is not working to continue. For years I believed the greatest compassion was helping the next patient through the system. I now think it may be refusing to accept a system that keeps producing the same suffering. 

Awareness without action changes little: a pink ribbon means little to the woman who recognises the warning signs of breast cancer, only to wait months for treatment.

So this October, I will wear black: not as a symbol of despair, but as an act of reflection and, frankly, of grief. To mourn the preventable suffering we have allowed to become normal. To mourn our shrinking moral horizon.

To say that our patients, our healthcare workers and the most vulnerable among us deserve better.

Accountability is not the opposite of hope. It is one of hope’s highest expressions: we only demand better from institutions when we still believe they can become better. Against all odds, I still do.

But believing is no longer enough. I will dare to be outraged. I will dare to remain shocked. I will keep participating. And for the first time in decades, I will put the pink away.

I will wear black. DM