“It’s not a death sentence”: How frontline health workers are changing breast cancer care in Zambia and Uganda

A community health worker in Masala, Lusaka, said this after completing training in breast cancer awareness and early detection. Many people we met in Zambia and Uganda did not know that either. Today, over 1.3 million people across the two countries have heard that breast cancer can be treated when it is found early, and the frontline health workers who told them are the heart of this story. 

These are some of the results from our ‘Focus on Breast Cancer’ programme, with funding and support from Sanofi.

In many parts of Zambia and Uganda, a woman with a breast lump is far more likely to meet a community health worker or a nurse at her local clinic than a specialist. Specialist care can be hours away, and fear, stigma and myths often keep people from seeking help at all. If frontline workers can recognise the signs, examine confidently and refer quickly, cancers are found earlier, when treatment is far more likely to be successful. 

With Sanofi’s support, we worked with the Ministries of Health, the Uganda Cancer Institute, the Cancer Diseases Hospital in Lusaka, and our technical partners, the Association of Breast Surgery and Blended Learning UK, to equip primary and community health workers to do exactly that. Cancer survivors helped shape the training. They asked that health workers learn not only clinical skills but also how to listen and support women through the uncertainty of diagnosis. 

The training uses a cascade approach. Master Trainers train primary health workers, who train community health workers, who carry the message into homes, markets, churches and clinics. Tests before and after training show clear gains in knowledge. The share of learners scoring highly rose from 26% to 51%, and over 97% now understand that breast cancer is curable when found early.

For many community health workers, the biggest change was in what they believed. One from Kamwala South Health Post said: “Little did I know that even men can have breast cancer, but after learning, I am now able to go out there and educate the public.” In Chawama, another explained why this matters: “People will be aware that cancer is not a death sentence, but if detected early it can be curable.” 

Fear is often what keeps women away. A community health worker in Mushili put it plainly: “Knowledge is power, as most women are dying because they lack information and fear visiting clinics, and only go when it’s too late.” 

Primary health workers told us the training changed how they practise. “It was a wonderful experience and definitely an eye opener to things we health workers tend to take lightly or overlook, especially the importance of early detection and referral,” said one Zambian participant. A nurse in a surgical department described a practical change: “I help with follow-up of biopsy, as most results take several months, but now I have direct contact. It’s a phone call away.” 

In Uganda, a midwife at Endinzi Health Centre III said: “This training made a significant impact on me as a primary health worker and my district as a whole.” Another trainee wrote that the sponsors “opened our eyes” to knowledge that can help people to “to carry out breast self-examination and to teach others.” A third promised: “I am ready to put all that I’ve learnt into daily practice.” 

They are keeping that promise. In Uganda, health workers can now phone doctors at the Mbarara Regional Cancer Centre and the Arua Satellite Cancer Centre directly. Before, many referred patients simply disappeared after facing long queues at the referral hospital. Now they have a direct contact they can call when patients arrive. 

As of mid-2026, more than 1.3 million people in Zambia and Uganda have been reached with information about breast cancer. Over 190,000 people have been examined by trained health workers, with 321 abnormal findings identified. More than 1,500 people have been referred for further investigation. 

Behind these numbers are 1,109 health workers trained across the two countries: 16 Master Trainers, 17 Trainers of Trainers, 329 primary health workers and 747 community health workers. Around 200 mentorship sessions have helped them turn what they learned into everyday practice.

Because the training is embedded within existing public health systems, its benefits can extend beyond the life of the project. Master Trainers continue to mentor, and new Assistant Master Trainers are being identified in Zambia. In Uganda, research from the project, supported by Sanofi, is being published in a peer-reviewed journal so that what we have learned can shape breast cancer programmes elsewhere. 

There is more to do. Referral and follow-up systems still need strengthening, and diagnostic capacity in some areas remains limited. We will continue working with partners to strengthen these areas as the project moves into its final stage. 

We thank Sanofi for supporting this frontline approach to breast cancer, and our partners at the Association of Breast Surgery and Blended Learning UK, the Ministries of Health, the Uganda Cancer Institute and the Cancer Diseases Hospital. Above all, we thank the health workers and survivors in Zambia and Uganda who are turning training into care. As one of them told us, breast cancer is not a death sentence. Early detection saves lives, and it starts in the community.