They have medical cover, so why are so many South Africans skipping cancer screening?

HQA's data shows that the proportion of eligible women who had not undergone a mammogram over five years has declined steadily since 2019.

Large numbers of South Africans with medical scheme cover are not making use of cancer screening benefits available to them, according to new healthcare quality data.

The Health Quality Assessment's (HQA) latest industry report, based on 2025 data from 7.38 million medical scheme beneficiaries, found that screening for colorectal and breast cancer remained low despite gradual improvement in some measures.

More than 85% of beneficiaries aged between 50 and 75 had not undergone colorectal cancer screening during the previous five years.

Even so, HQA said the proportion of beneficiaries who had undergone screening by colonoscopy had increased steadily since 2019 and continued to rise in 2025. Faecal occult blood test screening also increased during the year, although overall uptake remained low.

HQA said greater awareness and participation from members, recommendations from healthcare practitioners and continued efforts by medical schemes to promote available benefits all had a role to play in increased testing.

Among female beneficiaries aged 40 to 75, 23.5% had received at least one mammogram in the previous two years in 2025, while 64% had not had a mammogram during the previous five years.

There has been some progress. HQA's data shows that the proportion of eligible women who had not undergone a mammogram over five years has declined steadily since 2019. The report also found considerable variation between medical schemes, indicating that higher screening rates are being achieved by some schemes.

HQA chief executive Louis Botha said having a screening benefit was only the first step towards improved medical care. “Providing screening and preventive benefits is an important first step, but those benefits can only contribute to better health outcomes when people use them,” he said.

The screening figures contrast with some of the improvements recorded in chronic disease monitoring.

Diabetes care, for example, has shown a sustained improvement over the period HQA has been measuring it. In 2025, 75.6% of beneficiaries registered for chronic medication benefits for diabetes received at least one HbA1c test during the year.

The test is used to monitor average blood glucose levels over approximately three months. The proportion receiving the recommended minimum of two HbA1c tests a year also increased steadily from 2021, reaching 42% in 2025.

HQA's survey covers more than 200 healthcare quality indicators and represent more than 84% of South Africa's insured medical scheme population.

HQA said the diabetes figures demonstrated the value of tracking healthcare quality over time. “It allows us to see that improvement is possible and then to ask what has contributed to that progress and how those lessons might be applied elsewhere,” Botha said.