7 Minutes
In this article we answer the following questions:
- What are the most common cancers in South Africa?
- When should I start getting screened for breast cancer?
- How is cervical cancer screening done?
- What is a PSA test?
- At what age should I start colorectal cancer screening?
Cancer affects thousands of South Africans every year, and that reality can feel overwhelming. Four cancers account for the majority of cases in South Africa: breast cancer, cervical cancer, prostate cancer, and colorectal cancer. Screening can save lives by detecting disease early, when it’s most treatable. Understanding your risk factors and knowing when to screen can be the key to early detection. Regular screening tests for these cancers are available and, in many cases, can catch problems before symptoms even appear.
Cancer in South Africa by number
In women, breast cancer is the most common cancer, accounting for 24% of all cancer cases. Cervical cancer is the second most common cancer in South African women, representing 17% of all female cancer cases. It is one of the leading causes of cancer death, particularly affecting women between the ages of 30 and 50.
In men, prostate cancer is the most common cancer, accounting for 26% of all male cancer cases. Research shows that black men are at higher risk for aggressive prostate cancer and are more likely to present with advanced disease, which may be linked to genetic factors as well as limited access to screening services.
Colorectal cancer affects both men and women. It’s the fourth most common cancer in men and the fifth most common in women, accounting for a total 3600 cases per year.
What you need to know about breast cancer
Breast cancer develops in the cells of the breast tissue. While it can affect anyone, certain factors can increase your risk:
- Age over 40
- Family history of breast cancer
- Certain genetic mutations (BRCA1 and BRCA2)
- Never having children or having your first child after age 30
- Obesity and lack of physical activity
- Alcohol consumption
Though breast cancer is far more common in women, men can develop it too.
Who should screen and when:
The Cancer Association of South Africa (CANSA) recommends annual screening mammograms for women aged 40-54 years, and biennial (every two years) mammography for women 55 years and older. The Radiological Society of South Africa recommends annual screening from 40 to 70 years, along with regular self-examination and clinical breast exams.
How to screen for breast cancer:
Breast self-examination involves checking your own breasts each month for lumps, changes in size or shape, skin changes, or any nipple discharge. When you get to know how your breasts normally look and feel, you’ll be more likely to notice if something changes.
Clinical breast examination is when your doctor or nurse manually checks your breasts and underarm area for lumps or other changes. It’s a simple part of your regular health check.
A mammogram is an X-ray that looks at your breast tissue more closely. You’ll stand in front of a special X-ray machine, and a technologist will gently position your breast on a flat plate. Another plate presses down from above to flatten your breast slightly whilst the image is taken. This pressure only lasts a few seconds, and whilst it might feel uncomfortable, it helps create a clearer image and actually reduces the amount of radiation needed. The process is repeated for a side view, then done for your other breast. The whole procedure takes about 20 minutes.
Cervical cancer explained
Cervical cancer develops in the cervix, which is the lower part of the uterus that connects to the vagina. Nearly all cervical cancer cases are caused by persistent infection with high-risk types of human papillomavirus (HPV).
Risk factors include:
- HPV infection
- HIV infection, which significantly increases your risk
- Smoking
- Multiple sexual partners
- Early sexual activity
- Weakened immune system
Who should screen and when:
South African guidelines recommend that all women start screening from age 25. You should have a screening at least every three years. If you’re living with HIV, you may need screening annually, as you’re at higher risk of cervical abnormalities. Screening can be stopped at age 50 after three negative screening tests, or at age 60 after a normal test if you’ve had any previous abnormal results.
How to screen for cervical cancer:
A pap smear checks for abnormal cells on your cervix. During the test, you’ll lie on an examination table with your feet supported in stirrups. Your doctor will insert a speculum to reach your cervix, then use a small brush or spatula to collect cells. The sample is sent to a laboratory for analysis. The entire procedure takes only a few minutes. You might feel mild cramping that passes quickly. Some light spotting or cramping for a few hours afterwards is completely normal.
HPV testing can be done at the same time as your Pap smear or separately. Current South African guidelines recommend primary HPV screening with partial genotyping, as this approach is more effective at detecting high-risk cases.
Preparing for your Pap smear:
Avoid sexual intercourse, douching, vaginal creams, tampons, and other vaginal products for at least two days before your test. Try to schedule your appointment when you’re not menstruating, as this helps ensure the most accurate results.
The facts about prostate cancer
Prostate cancer develops in the prostate gland, a small walnut-shaped gland that produces seminal fluid in men.
Risk factors include:
- Age over 50
- Family history of prostate cancer
- Being of African descent
- Obesity
Who should screen and when
Screening recommendations vary, but most men should talk to their doctor about prostate cancer screening starting around age 50. If you’re at higher risk—including black men and those with a family history—you should consider starting these conversations earlier, around age 40 to 45. It’s worth noting that prostate cancer is detected more often in the private healthcare sector, largely due to better access to screening services.
Screening methods
The PSA (prostate-specific antigen) test is a blood test that measures levels of PSA, a protein your prostate produces. Higher PSA levels can indicate prostate problems, including cancer, though elevated PSA doesn’t always mean cancer is present. PSA testing is currently the most accurate blood test for detecting prostate cancer.
A digital rectal examination (DRE) involves your doctor inserting a gloved, lubricated finger into your rectum to feel your prostate gland for any changes in size or unusual growths. The procedure takes only a minute or two. DREs can sometimes detect prostate cancer even when PSA levels are normal.
If either test shows concerning results, your doctor may recommend further imaging or a biopsy to examine your prostate tissue more closely.
Understanding colorectal cancer
Colorectal cancer develops in the colon (large intestine) or rectum. It often begins as small growths called polyps that can become cancerous over time.
Risk factors include:
- Age over 50
- Family history of colorectal cancer or polyps
- Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
- Diet high in red and processed meats and low in fiber
- Lack of physical activity
- Obesity
- Smoking and heavy alcohol use
- Type 2 diabetes
Who should screen and when
If you’re at average risk, most guidelines recommend you begin screening between age 45 and 50. If you have a family history or other risk factors, you may need to start earlier. Screening typically continues until age 75, or longer depending on your health and previous screening results.
Screening methods
A colonoscopy is the most comprehensive screening test for colorectal cancer. It involves using a long, flexible tube with a tiny camera on the end to view the inside of your entire colon and rectum. Before the procedure, you’ll need to complete bowel preparation, which is drinking a special solution that clears out your colon. During the colonoscopy, you’ll be sedated for comfort. The doctor inserts the colonoscope through the rectum and carefully examines the colon lining. If polyps are found, they can often be removed during the same procedure. The examination takes 30-60 minutes, but you’ll need extra time for sedation and recovery.
Other screening options include faecal occult blood tests (which check for hidden blood in stool samples) and flexible sigmoidoscopy (which examines only the lower part of the colon), but colonoscopy is the best way to screen because it examines the entire colon and allows for polyp removal.
Early detection saves lives. Talk to your healthcare professional about which screening tests are right for you based on your age, family history, and personal risk factors. Many cancers are highly treatable when caught early. Regular screening gives you the best chance of detecting problems before symptoms appear.
References and additional reading:
- Cancer Association of South Africa (CANSA) (2024) Breast cancer. Available at: https://cansa.org.za/breast-cancer/
- Cancer Association of South Africa (CANSA) (2024) Cancer screening at CANSA Care Centres and Medical Centres. Available at: https://cansa.org.za/cansas-care-support/cancer-risk-reduction-screening/
- Cancer Association of South Africa (CANSA) (2024) Colorectal cancer. Available at: https://cansa.org.za/colorectal-cancer/
- Cancer Association of South Africa (CANSA) (2024) South African cancer statistics. Available at: https://cansa.org.za/south-african-cancer-statistics/
- Busamed (2025) Colon cancer screening. Available at: https://busamed.co.za/articles/colon-cancer-screening/
- Hollard (2024) Higher rate of prostate cancer among black men needs awareness. Available at: https://www.hollard.co.za/media-centre/press-releases/prostate-cancer-prevalence-in-black-men
- National Research Foundation (2022) Breast cancer in South Africa: from incidence to intervention. Available at: https://www.nrf.ac.za/breast-cancer-in-south-africa-from-incidence-to-intervention/
- South African Society of Gynaecological Oncology (2024) Clinical guideline for cervical cancer screening. Available at: https://sasog.co.za/wp-content/uploads/2024/07/BetterGyn-Clinical-Guideline-for-cervical-cancer-screening-2024.pdf
- Ampath Laboratories (no date) Prostate cancer screening. Available at: https://www.ampath.co.za/storage/433/prostate-cancer-pamphlet-a4.pdf
- Mediclinic (2024) Why prostate check-ups are crucial. Available at: https://www.mediclinic.co.za/en/infohub-corporate/expertise/urology/why-prostate-check-ups-are-crucial.html