The study, which encompassed 43 hospitals around South Africa, also found that while there are pockets of excellence in the public healthcare sector and treatment typically commences within national guidelines, wide disparities exist in patient access to diagnostics and in key surgical interventions such as biopsies and breast reconstruction.

The upshot is that two-thirds of South African women diagnosed with breast cancer are at a much-heightened risk of dying of the disease. And with the incidence of cancer in our country projected to double by 2030, it’s clear that this state of affairs will only worsen.

One promising area is theranostics: a branch of nuclear medicine that links molecular imaging with targeted treatment. It does not replace established breast-cancer care. Rather, it aims to help clinicians understand each patient’s cancer more precisely and, where appropriate, select treatment more intelligently.

This portmanteau of “therapy” and “diagnostics” clearly and simply tells us what it is. In practical terms, it means using an imaging test to identify a molecular target on cancer cells and then using a matched treatment designed to reach the same target. This approach can support more personalised treatment planning and monitoring over time.

One such target is trophoblast cell-surface antigen 2, or Trop2. Trop2 is frequently expressed in triple-negative breast cancer and in several other epithelial cancers, including cervical, pancreatic and lung cancers.

The idea of using Trop2 to deliver precise diagnosis and treatment has been around for at least 15 years, but until now we’ve lacked a good vehicle for labelling this great molecule in a way that is safe. The next scientific opportunity is to develop a practical, high-resolution PET imaging approach that can support whole-body assessment, patient selection and future therapy development.

Hence, the choice of nanobodies, which are tiny, engineered antibody fragments that can be designed to bind specifically to targets such as Trop2. Because they are much smaller than conventional antibodies, they can reach tumours rapidly and usually clear from the bloodstream faster, helping to produce high-contrast images within a clinically practical time window.

Through a long-standing collaboration with researchers at KU Leuven in Belgium and the Joint Research Centre (JRC) in Karlsruhe, together, we are developing a Trop2-targeted theranostic platform and will evaluate its safety, imaging performance and clinical feasibility.

This is what my team and I are setting out to achieve with the support of the 2025 Harry Oppenheimer Fellowship Award, which I am honoured to receive from the Oppenheimer Memorial Trust (OMT), a philanthropic institution that supports South African academia and science, education, social justice and the arts, which benefits all humanity.

The R3-million grant will help us generate the evidence needed to move this platform closer to clinical translation. The goal is to build a credible pathway towards more precise, patient-centred cancer care.

So, how does this approach work?

In essence, the project links diagnostic imaging and potential therapy around the same Trop2 target, using fluorine-18 for PET/CT imaging and actinium-225 for targeted alpha-therapy development.

For imaging, fluorine-18 is attached to a Trop2-targeting nanobody – not directly to Trop2 itself. After injection, the nanobody seeks out Trop2 on cancer cells. A PET/CT scan then detects the fluorine-18 signal and creates a whole-body map of where the Trop2 is found.

Positron emission tomography, or PET, is an advanced imaging method that uses a small amount of radioactive tracer to show biological activity in the body. When combined with CT, it can show both the location of disease and the molecular features that may be relevant to treatment. This can complement biopsy results across lesions that may be difficult or unsafe to sample repeatedly.

Fluorine-18 is widely used in PET because it has favourable imaging properties, a practical half-life and established production methods.  Where imaging confirms sufficient Trop2 expression, a matched Trop2-targeting treatment can be explored using actinium-225. Actinium-225 is an alpha-emitting isotope with a physical half-life of about 10 days. Its alpha particles travel only a very short distance in tissue, giving it the potential to concentrate a powerful radiation effect in targeted tumour cells while limiting exposure to nearby healthy tissue.

Reliable access to actinium-225 is essential for the future of targeted alpha therapy. Global production is expanding, but supply remains constrained. Strengthening South Africa’s radiopharmaceutical capability, global partnerships and workforce is therefore an important part of making future therapies more sustainable and accessible.

Oncology, including nuclear medicine, can be resource-intensive. Yet the cost of cancer care must be considered across the entire patient pathway: delayed diagnosis, unnecessary treatment, repeated hospital visits and loss of opportunity for effective intervention also carry a heavy human and economic burden. Technologies that improve treatment selection may ultimately help make care more efficient, but this must be demonstrated through rigorous clinical and health-economic research.

The lesson from other major health challenges is that progress comes when scientific innovation is matched by testing, treatment, strong health systems and equitable access. For cancer, that means investing in prevention, earlier diagnosis, accurate staging, evidence-based treatment, survivorship care and research that can make those interventions more precise.

We should be ambitious, but also careful. Many breast cancers can be cured, especially when diagnosed early and treated promptly. For advanced disease, the aim is to extend and improve life through better treatment choices. Theranostics may become one important part of that future, but it must be tested rigorously and introduced responsibly.

South Africa can help lead this next chapter. We need well-designed clinical studies, sustained philanthropic and public investment, responsible partnerships with industry, and a commitment to ensuring that innovation is relevant to patients in the public health system as well as the private sector.

We already have important infrastructure on which to build. The Nuclear Medicine Research Infrastructure (NuMeRI), hosted by the University of Pretoria and Steve Biko Academic Hospital, is a national research facility, which brings together radiopharmacy with a cyclotron, hotcells and quality control labs capability, molecular imaging, medical physics and radiobiology, translational research, preclinical imaging and clinical expertise. This ecosystem makes it possible to develop, evaluate and translate new radiopharmaceutical approaches in South Africa.

Bringing together patients, academic and commercial stakeholders will create a win-win situation and create a more coordinated response to breast cancer. The prize is not simply a new technology. It will benefit the world by generating a scalable theranostic model for Trop2-positive cancers. For these reasons, this project is scientifically compelling, clinically urgent, nationally strategic and globally relevant.

This article originally appeared in Mail & Guardian on 19 Jul 2026: https://mg.co.za/thought-leader/2026-07-19-making-breast-cancer-more-manageable-treatable-and-survivable/