Breast Cancer “Awareness”: What is the Message?

Each year during the month of October we are more than ever bombarded with the pink ribbon. But what really is the purpose of all this “awareness” today–beyond selling pink-ribboned products?

Breast cancer screening through mammography has now become widespread, but misperceptions about the disease are also widespread.

How do we get to a more informed level of awareness–the kind of awareness that may better lead to the steps that need to be taken today to end deaths from this disease?

In my view, true awareness of breast cancer and its impact needs to start with facts like these.

1. Breast cancer remains an often lethal disease, accounting for the second highest number of annual cancer deaths for women in the United States.

The American Cancer Society (ACS) reports that there will be an estimated 275,710 deaths from cancer among females in the United States in 2014. Over a quarter of those (the deaths of 72,330 women) will be from lung cancer.*

Another 15% (the deaths of about 40,000 women in 2014) will be from breast cancer. The next most lethal cancers for U.S. women are colon, pancreatic, and ovarian cancer, which account for 9%, 7% and 5% of deaths, respectively.

And although these figures are about women, it’s important to recognize that men get breast cancer too. It’s estimated that 430 U.S. males will die from breast cancer in 2014.

2. The decline in the breast cancer mortality rate, or deaths per unit of population, over the last twenty years has been modest.

Reductions in cancer mortality rates have been modest for most types of cancer.

For U.S. females, of the top five cancer sites listed above, only two–breast cancer and colon cancer–have shown declines in mortality rates over the past twenty years. Over that same time period, mortality rates for cancers of the lung, pancreas and ovary have remained essentially unchanged.

The decline in the breast cancer mortality rate over the last twenty years has been modest. According to the ACS, after slowly increasing from 1975 through 1990, breast cancer death rates for all women in the United States decreased by 34% from 1990 to 2010. Even with this decline, as noted above, over 40,000 are expected to die from the disease in one year.**

3. There are striking divergences in cancer mortality across ethnic groups. This is particularly true for breast cancer.

Even the modest improvement in breast cancer mortality over the last two decades has not been consistent across ethnic groups. Breast cancer mortality trends for African American and white women began to diverge in the early 1980s. And by 2010, death rates were 41% higher in African American than white women.

This divergence reflects the broader reality that African Americans are more likely to develop and die from cancer than any other racial or ethnic group.*

4. The long-term adverse side effects of having been treated for cancer can have a major impact on quality of life in many areas and are not limited to the side effects of medication.

Chemotherapy drugs can cause damage to the heart, lungs, kidneys and reproductive organs, as well as the nervous system. Removal of lymph nodes as part of breast cancer surgery can cause a chronic condition, known as lymphedema, which results from the build-up of fluid in the arm and causes swelling and pain.

Long-term adverse effects of treatment also often include anxiety, depression, infertility and problems with sexuality. Chemotherapy and hormone therapy have been shown to cause cognitive problems including learning, memory and attention difficulties.

And research shows that one of the top quality of life issues for breast cancer patients today is economic burden, which can include the loss of income from not being able to return to work as well as the exponentially rising prices of cancer drugs.

5. The benefits of mammography as a screening tool are more limited than some awareness campaigns suggest. Better screening tools are needed.

Mammography as a screening tool does not prevent breast cancer, has both benefits and costs, and is most beneficial for women who are at higher risk for breast cancer.

A large majority of women in the United States are now being screened for breast cancer. Based on data from the Centers for Disease Control and Prevention, roughly 60% of women over 40 reported having had a mammogram within the past year.**

Yet, mortality has not declined nearly as much as might have been expected with this level of screening coverage. In contrast, mortality from cervical cancer–once one of the most common causes of cancer death for American women– declined almost 70% as a result of increased use of the Pap test.

How can we do better?

The modest improvement in breast cancer mortality that has occurred is generally attributed to some combination of better treatments and screening. We need to do a whole lot better on both fronts.

To get there, we need to insist on adequate funding for research along with more coordinated efforts to find treatments that are both less toxic and more effective in saving lives–and to fully understand, so that we can eliminate, the disparity in outcomes across ethnic groups.

With respect to research funding, we’re actually going in the opposite direction of where we need to be right now. The American Society of Clinical Oncology notes that federal funding for cancer research has remained flat over the last decade, and when inflation is taken into account, has actually declined.

Coordination is key. For insight into many ways in which lack of coordination among researchers is slowing down progress, “The Truth In Small Doses” by Clifton Leaf is a very informative read.

There are groups that are working hard to bring researchers together. For example, Stand Up 2 Cancer funds translational research that emphasizes collaboration among scientists to tackle major problems such as how to overcome treatment resistance in breast cancer. Breast cancer advocates, through the National Breast Cancer Coalition, have been working with scientists to identify the priority questions that need to be answered and to bring together the necessary scientific expertise to get that work done. These are the kinds of efforts that need to be supported and built upon in order for all the years of “awareness” to bring the results that have long been hoped for.

*Source: American Cancer Society (ACS), Cancer Facts & Figures, 2014
**Source: ACS, Breast Cancer Facts & Figures, 2013-2014

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