The overwhelming number of cases and the paucity of funds, doctors and treatment mean it’s difficult to know where to start, Kerr says. But cancer experts - foreign and African - and patients and advocacy groups say what’s needed first is greater awareness.

KNOWING THE ENEMY

Ellen Awuah-Darko is doing what she can.

The 75-year-old founder of the Accra-based Jead Foundation for breast cancer says her own experience - of finding a lump and ending up paying tens of thousands of dollars to be treated in the United States - made her to try force change.

“In America I had to put down $70,000 before they’d even talk to me,” she said. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women breast screening. It’s not the high-tech mammogram or ultrasound scan women in wealthy countries are used to, but a simple breast examination and a lesson in how to self-check.

“Early detection can save your life. I want everybody to know that. It’s not something people should be ashamed of or embarrassed about,” she said.

But she and the handful of cancer specialists are fighting deep cultural resistance - not only to the idea that cancer affects people here, but also to the idea they must talk about it, look for it and recognize it to start fighting against it.

Even among the young and educated, cancer is often taboo.

“They don’t want to use the C-word,” says Vanderpuye. “That’s also one of the main reasons why someone wouldn’t want to come here - because it means she has ‘the C’.

“HUMONGOUS FOUL-SMELLING TUMOURS”

In the chemotherapy ward at Korle Bu, oncology nurse Juliana Tagoe, explains why patients often don’t want to talk about cancer.

Many people see the disease as a spiritual punishment, she says. “They think someone has done wrong and this is the effect - God is punishing them. They feel stigmatized.”

In rural communities where spiritual and tribal leaders are revered, the use of prayer, ritual and herbal remedies is common. Awuah-Darko says witch doctors tell patients with tumors to “treat it like a boil, and just put some herbs on it”. Others are told simply to pray for it to be taken away.

In the months or years that intervene, the tumors spread and grow to sizes barely seen by doctors in developed countries.

Kerr talks of patients in Africa with tumors that protrude through the breast or encircle the whole chest, while Vanderpuye describes patients with “humongous, foul-smelling tumors” she has little hope of treating.