Tove Ekdahl Hjelm's doctoral research has uncovered a stark reality: while most breast cancer patients in Sweden can be diagnosed early and cured, women with the same disease in Uganda and Ethiopia are often diagnosed so late that tumors have already spread to lymph nodes or other organs—and most will not survive. The findings, presented in her thesis "Early-onset breast cancer in East Africa: genetics, tumor characteristics and clinical management" defended at the Karolinska Institutet in June 2026, paint a picture of healthcare systems where the gap between diagnosis and survival is measured not in treatment options but in geography and resources.
The research focused on young women—often under 40—in Uganda and Ethiopia, regions of Sub-Saharan Africa where no national breast cancer screening programs exist. Ekdahl Hjelm and her team investigated access to surgery, disease stage at diagnosis, dominant tumor types, and the prevalence of hereditary breast cancer. What they found was a cascade of barriers from detection to treatment.
In Uganda, only a fraction of the estimated number of women who develop breast cancer actually underwent surgery. Patients in Ethiopia were diagnosed at substantially later disease stages than their Swedish counterparts. Most strikingly, only one in five patients with potentially curable disease initiated their full recommended treatment course—the combination of surgery, chemotherapy, radiotherapy, and hormonal therapy that offers the best chance of survival. The root cause was not lack of medical knowledge but lack of access: diagnostics, surgery, radiotherapy, and cancer medications are all severely limited in these settings.
One discovery proved particularly significant. More than one in five patients screened carried a pathogenic mutation in genes strongly linked to breast cancer risk—BRCA1, BRCA2, or PALB2. This rate, substantially higher than in many other populations, suggests that hereditary factors may play a major role in breast cancer development in Ethiopia. The finding opens a pathway: if high-risk individuals could be identified and offered focused early-detection strategies, diagnosis at curable stages becomes possible.
The tragedy embedded in these numbers is also their potential solution. Ekdahl Hjelm emphasizes that the gaps are not inevitable. They reveal a clear roadmap for intervention: strengthening early detection systems, expanding access to surgery and cancer drugs, building radiotherapy capacity, and establishing genetic counseling and testing adapted to local resources and conditions. The research demonstrates that with targeted effort, more patients could be diagnosed when cure is still possible.
Ekdahl Hjelm's ambitions extend beyond documenting the problem. She is committed to continuing research in global oncology with the explicit goal of improving patient care in low-income regions. She envisions collaborative projects between Swedish researchers and colleagues in East Africa focused on early detection, prevention, and improved treatment—particularly developing and implementing new diagnostic technologies and treatment prediction tools suited to environments where resources are limited but needs are urgent.
The thesis, published by the Karolinska Institutet, stands as both a diagnosis of a crisis and a blueprint for change. It reminds us that survival from cancer remains determined not solely by the disease itself, but by where you live and what healthcare systems surround you—and that closing that gap is possible.