Jessy Acen, 30, who has advanced breast cancer, is bathed by her twin sister at home in the city of Gulu, in northern Uganda. Ms. Acen, a tailor, has two young sons. Lynsey Addario for The New York
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Lynsey Addario for The New York Times
Jessy Acen, 30, who has advanced breast cancer, is bathed by her twin sister at home in the city of Gulu, in northern Uganda. Ms. Acen, a tailor, has two young sons.
Lynsey Addario for The New York Times
Mable Mutamba, 37, has advanced breast cancer that has broken through the skin and eaten away much of her right breast. She tried to treat the disease with herbs for about a year before seeing a doctor. Ms. Mutamba, a farmer and basket weaver who has five children, ages 1 to 16, is shown with her niece.
Lynsey Addario for The New York Times
Edith Kemigisha, 9, screams and weeps as she looks at the dead body of her mother, Jolly Komurembe, hours after she died of advanced breast cancer and before being transported to her village for burial in Western Uganda, in Kampala, Uganda. Jolly Komurembe, 40, who died from breast cancer that had spread to her liver and other organs.
Lynsey Addario for The New York Times
Patients awaiting radiation treatment at Mulago Hospital in Kampala. The hospital has Uganda's only radiation machine.
Lynsey Addario for The New York Times
Mary Namata, 48, outside her home in the town of Buddo, near Kampala. Ms. Namata, who has large tumors in her right breast, later began chemotherapy at the Uganda Cancer Institute in Kampala, to shrink the lumps in preparation for a mastectomy.
Lynsey Addario for The New York Times
Mary Namata, 48, is being prepared for a needle biopsy at Mulago Hospital in Kampala, by a physician visiting from the United States, Dr. Constance Lehman, a radiologist at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle. Ms. Namata's tumors have gone untreated for about four years.
KAMPALA, Uganda — Mary Namata unbuttoned her dress in an examining room at Mulago Hospital, revealing a breast taut and swollen with grape-size tumors that looked as if they might burst through the skin.
“How long have you had this?” a doctor asked gently. Ms. Namata, 48, an elegant woman with stylishly braided hair and a flowing, traditional Ugandan dress, looked away, shamefaced.
“About a year,” she murmured. The truth, she admitted later, was closer to four years.
Such enormous tumors, rare in developed countries, are typical here. Women in Uganda, trapped by stigma, poverty and misinformation, often do not see help for breast cancer until it is too late.
For Ms. Namata, though, there was still hope that the cancer had not yet spread beyond the breast, her doctors said. Treatment could prolong her life, maybe even cure her — if it started soon.
But would she be treated in time? Women in Africa often face perilous delays in treatment as a result of scarce resources, incompetence and corruption. Would Ms. Namata wind up like so many women here, with disease so far gone that doctors can offer nothing but surgery to remove rotting flesh, morphine for pain and antibacterial powder to kill the smell of festering tumors that break through the skin?
Cancer has long been neglected in developing countries, overshadowed by the struggle against more acute threats like malaria and AIDS. But as nations across the continent have made remarkable progress against infectious diseases once thought too daunting to tackle, more people are living long enough to develop cancer, and the disease is coming to the forefront. Given the strides poor countries have made against other health problems, they should also be able to improve the treatment of cancer, public health experts increasingly say.
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