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Global breast cancer report finds inequities persist

Lancet breast cancer commission

Published: 16 April 2024

A new Lancet Commission sets out recommendations to tackle urgent global challenges in breast cancer. Supported by the NIHR, the Commission reveals that despite significant improvements inequities persist.

At the end of 2020, 7.8 million women were alive after being diagnosed with breast cancer in the previous five years. This reflects progress in research which has led to a decrease of over 40% in breast cancer mortality in most high-income countries (HICs).

However, 685,000 women died from the disease in 2020. One million deaths from the disease per year are projected by 2040. Low-and middle-income countries (LMICs) are disproportionately affected.

The Commission’s lead author, NIHR Research Professor, Charlotte Coles, Professor at the Department of Oncology, University of Cambridge, UK, and Oncology Consultant at Cambridge University Hospitals NHS Foundation Trust, said: “Recent improvements in breast cancer survival represent a great success of modern medicine.

“However, we can’t ignore how many patients are being systematically left behind. Our Commission builds on previous evidence, presents new data, and integrates patient voices to shed light on a large unseen burden. We hope that, by highlighting these inequities and hidden costs and suffering in breast cancer, they can be better recognised and addressed by health care professionals and policymakers in partnership with patients and the public around the world.”

The number of people with MBC breast cancer is unknown

The number of people living with metastatic breast cancer (MBC) is unknown. MBC is breast cancer that has spread to another part of the body. Authors say not tracking the numbers hampers the provision of treatment.

They make a case for 70% of registries worldwide to record the cancer stage and relapse. This could drive significant improvements in MBC care, outcomes, and emotional wellbeing.

Exposing hidden costs of breast cancer

The associated costs of breast cancer are under-recognised according to the Commission. These include physical, psychological, social, and financial costs.
In response, the Commission established the CASCARA UK-based pilot study funded by NIHR. It reviewed the economic burden and care needs for people with breast cancer. Nearly all the 606 people living with breast cancer and carers surveyed stated physical or well-being issues.

The Commission report also discusses serious health-related suffering (SHS). This is an indicator of the need for palliative care. Based on the 685,000 global breast cancer deaths in 2020, an estimated:

  • 120 million days were spent with SHS per year for people who died of their cancer
  • 520 million days were estimated for patients living with the disease

The Commission advocates for new tools to capture costs associated with the disease. This measurement should guide policymakers to invest in:

  • breast cancer prevention
  • early detection
  • cost-effective therapy
  • optimal management
  • financial protection
  • other interventions that relieve suffering

Better communication for better patient outcomes

Healthcare professional-patient communication that empowers an important intervention, the authors highlight. They suggest better communication with patients can improve:

  • quality of life
  • decision-making
  • body image
  • adherence to therapy

The Commission calls for 100% of healthcare professionals to receive communication skills training. It also calls for patient involvement in all stages of clinical research on breast cancer. To support these transitions, the report outlines a framework to:

  • build rapport and empathy
  • share information
  • check understanding
  • jointly agree next steps with patients

Collaborate to improve prevention and early detection

The Commission suggests up to one-quarter of breast cancer in HICs could be prevented by modifying risk factors. This includes minimising alcohol consumption, being overweight, and physical inactivity.

They add that approaches identifying those at increased risk of breast cancer are essential. This will help enable equitable access to personalised prevention strategies.

The authors also argue for improved early detection programs, beginning with efforts to promote stage shifting in diagnosis so that at least 60% of confirmed invasive cancers are early disease (stages one or two).

Professor Benjamin Anderson, Departments of Surgery and Global Health, University of Washington, USA, medical officer at the World Health Organization from 2021 to 202 said: “In all countries, women with low incomes from minoritised backgrounds often have breast cancer diagnosed at a late stage, with a higher risk of dying.

“Our research lays out numerous other inequities in breast cancer that are at risk of widening further, and that can be addressed through global collaboration. Access to evidence-based prevention and care that isn’t dependent on where an individual lives or their ability to pay would reap wide-ranging benefits for patients, families, and health care systems striving to achieve universal health coverage. We urge decision-makers to implement our recommendations and accelerate progress on closing the breast cancer equity gap.”

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