Introduction : La capacité des associations à renforcer le pouvoir d’agir des personnes immigrées en France et touchées par la maladie a bien été montrée dans le champ du VIH. Dans le domaine des cancers du sein, il est reconnu que les espaces associatifs participent aux processus d’acceptation de la maladie et de la reconstruction de soi mais on sait peu de choses sur le rôle de ces associations auprès des femmes immigrées en France.
But de l’étude : Cet article propose de documenter le rôle des associations de lutte contre les cancers du sein dans les parcours spécifiques de femmes venues d’Afrique subsaharienne pour soigner leur cancer du sein en Île-de-France. À l’aide d’une méthodologie mixte (constitution d’une base de données et réalisation d’entretiens semi-directifs), nous avons quantifié le nombre d’associations présentes à Paris et dans la petite couronne, et documenté leur accessibilité pour ces femmes.
Résultats : En 2021, 514 associations de lutte contre les cancers du sein ont leur siège social à Paris et dans les départements de la petite couronne francilienne. Les entretiens ont révélé leur manque de visibilité et de spécificité pour les femmes originaires d’Afrique subsaharienne.
Conclusions : Les associations de lutte contre les cancers sont très nombreuses en Île-de-France mais elles sont peu accessibles et peu adaptées aux femmes originaires d’Afrique subsaharienne. Dans une perspective de lutte contre les inégalités sociales de santé, nous recommandons de créer des espaces d’énonciation de soi pour ces femmes, afin de soutenir leur parcours de vie, de soins et de reconstruction qui présentent des spécificités dans leur lutte contre la maladie.

Breast cancer is the second most common cancer, with more than 2.31 million cases diagnosed worldwide in 2022. Cancer medicine subjects the body to invasive procedures in the hope of offering a chance of recovery. In the course of treatment, the body is pricked, burned, incised and amputated, sometimes shattering identity and often changing the way women perceive the world. In sub-Saharan Africa, incidence rates are steadily increasing and women are particularly young when they develop breast cancer. Despite this alarming situation, the scientific literature on breast cancer in sub-Saharan Africa is poor and largely dominated by medical literature. Using a qualitative approach and a theoretical framework at the intersection of the sociology of gender and the sociology of the body, we explore the discourse strategies of women with breast cancer in Mali regarding their relationship to the body and to others. Based on 25 semi-directive interviews, we analyse the experiences of these women. Using the image of the Amazon woman, whose struggle has challenged gender because of its masculine attributes, we explore whether these women's fight against their breast cancer could be an opportunity to renegotiate gender relations. The experience of these women is characterised by the deconstruction of their bodies, pain and suffering. The masculinisation of their bodies and their inability to perform certain typically female functions in society (such as cooking or sexuality) challenges their female identity. The resistance observed through the sorority, discreet mobilisation and display of their bodies does not seem to be part of a renegotiation of gender relations, but it does play an active role in women's acceptance of the disease and their reconstruction.

Background Breast cancer is the most common cancer in terms of incidence and mortality among women worldwide, including in Africa, and a rapid increase in the number of new cases of breast cancer has recently been observed in sub-Saharan Africa. Oncology is a relatively new discipline in many West African countries, particularly Mali; thus, little is known about the current state of cancer care infrastructure and oncology practices in these countries.

Methods To describe the challenges related to access to oncology care in Mali, we used a qualitative approach, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight semistructured interviews were conducted with health professionals treating cancer in Mali (n = 10), women with breast cancer (n = 25), and representatives of associations (n = 3), and 40 participant observations were conducted in an oncology unit in Bamako. We used the theoretical framework on access to health care developed by Levesque et al. a posteriori to organise and analyse the data collected.

Results Access to oncology care is partly limited by the current state of Mali’s health infrastructure (technical platform failures, repeated strikes in university hospitals, incomplete free health care and the unavailability of medicines) and exacerbated by the security crisis that has been occurring the country since 2012. The lack of specialist doctors, combined with limited screening campaigns and a centralised and fragmented technical platform in Bamako, is particularly detrimental to breast cancer treatment. Women’s lack of awareness, lack of information throughout the treatment
process, stereotypes and opposition to amputations all play a significant role in their ability to seek and access quality care, leading some women to therapeutically wander and others to want to leave Mali. It also leaves them in debt and jeopardises the future of their children. However, the high level of trust in doctors, the involvement
of international actors, the level of social support and the growing influence of civil society on the issue of cancer also represent great current opportunities to fight cancer in Mali.

Conclusion Despite the efforts of successive Malian governments and the commitment of international actors, the provision of health care is still limited in the country, entrenching global inequalities in women’s bodies.

Keywords Cancer, Mali, Access to care, Barriers, Opportunities

While breast cancer is the most common cancer globally, not all women have access to quality care. Long considered a disease of high-income countries, low- and middle-income countries are now facing a major public health issue regarding cancer. This is the case in sub-Saharan Africa, where access to quality breast cancer treatment is often lacking. This context leads some women to travel abroad, particularly to France, hoping to save their lives. This article aims to examine the experiences, the social cost and the perceptions associated with therapeutic mobility for breast cancer in France. To this end, this study uses a qualitative method based on nineteen biographical interviews with women from sub-Saharan Africa with breast cancer who have migrated to France seeking for treatment. It shows that these women often face significant difficulties throughout their care and life paths in France. Main issues lay in accessing care, housing insecurity, loneliness, and administrative instability. This reflects how the double biographical disruption, caused by cancer and migration, impact entire disease trajectories, from entry to care to post-breast cancer period. With this research, we suggest extending the concept of social death to the issue of women who have undergone therapeutic mobility for their breast cancer in France. Highlighting the experiences of women who remain almost invisible in the public arena, this article analyses poorly heard realities and shows how social inequalities in health can be found even in reconstructing oneself after breast cancer.

Les taux d’incidence et de mortalité par cancers ne cessent d’augmenter en Afrique de l’Ouest. La cancérologie est une discipline récente au Mali et les moyens disponibles pour traiter les malades sont insuffisants. Le Mali compte un unique appareil de radiothérapie pour le pays et ses dysfonctionnements sont régulièrement relayés par les médias. Afin de comprendre les insatisfactions récurrentes liées à l’accès à la radiothérapie au Mali, nous avons retracé l’historique de cet appareil et en avons décrit le fonctionnement. À partir d’entretiens semi-directifs menés avec des associations de patientes et des professionnels de santé impliqués en cancérologie à Bamako, nous décrivons la façon dont l’appareil de radiothérapie du Mali révèle des enjeux de santé mondiale à travers l’intervention de nombreuses coopérations internationales. De façon complémentaire, et à partir d’une collecte de données sur registres médicaux et de rapports institutionnels, nous signalons que la durée moyenne pour obtenir un rendez-vous en radiothérapie est de trois à six mois au Mali, mais aussi que l’appareil de radiothérapie a fait face à 198 pannes entre le 3 avril 2014 et le 24 septembre 2021, ce qui représente plus de 54 semaines d’arrêts cumulés. La radiothérapie est un élément crucial de la prise en charge des cancers, et le manque d’accès à ce traitement aggrave le pronostic vital des malades. Alors que le gouvernement malien s’est engagé dans des réformes de couverture santé universelle, le renforcement des infrastructures de traitement des cancers doit également être considéré comme une priorité de santé publique pour le Mali.