Breast Cancer: How Much Progress Have We Made?

It’s October, and Breast Cancer Awareness Month in now well underway. As always during October, we’re surrounded by pink products, business promotions displaying the pink ribbon and pink-themed advertising–all in the name of breast cancer “awareness”. But how much real awareness does all this bring? Does it actually help patients at all?

Why not take a step back from all the craziness for a moment and take a look at where we actually are in the fight against breast cancer. Breast Cancer Awareness Month has been around for 30 years. It seems fair to ask: with all this awareness, how much progress have we actually made against breast cancer? And if it’s not enough: how can we, or will we, do better?

What Do the Numbers Tell Us?

Let’s start by taking a quick look at what the latest statistics from the American Cancer Society and the World Health Organization tell us about the progress that’s been made against breast cancer, in the United States and globally.

• Breast Cancer Deaths: An estimated 40, 730 breast cancer deaths are expected in 2015 in the United States, according to the American Cancer Society. Breast cancer ranks second as a cause of cancer death in women (after lung cancer).*
• Breast Cancer Mortality Rates:  Death rates per unit of population have declined only modestly over the last twenty years despite widespread screening. After slowly increasing from 1975 through 1990, breast cancer death rates for all women in the United States decreased by only about 34% from 1990 to 2010.**
• Socioeconomic Disparities: Even the modest improvement in breast cancer mortality rates over the last two decades has not been consistent across socioeconomic groups. A striking example is that the rate of death from breast cancer is now 41% higher for African American women than for white women in the United States.**
• Global Impact: It is estimated that over 500,000 women die each year from breast cancer. Almost 50% of breast cancer cases and 58% of deaths occur in less developed countries, the World Health Organization reports. Women in less developed countries tend to be diagnosed at later stages as a result of inadequate screening, diagnosis and treatment facilities.

What Needs To Change?

We need to do much better than this. These are some of the issues that directly affect these sobering statistics, and where we clearly have a long ways to go:

Newer Treatment Approaches: Most breast cancer patients, at least those who have access to quality care, still receive some combination of surgery, radiation and/or chemotherapy treatments–the old “slash, burn and poison”  regimen. Some receive additional targeted treatments, such as anti-hormone therapies or Herceptin, an antibody treatment, depending on the sub-type of breast cancer that they have.

But in most cases, these targeted treatments do not replace the standard treatments and often subject patients to additional side effects. For most patients, we do not yet have true precision medicine in breast cancer–where treatments would be targeted to the specific mutations in an individual’s cancer and patients would be spared the side effects of older treatments like chemotherapy. And the newer immune system therapies, which are showing much promise in the treatment of some types of cancer, are not yet available to treat breast cancer.

Metastatic Breast Cancer: It’s estimated that there are 155,000 Americans currently living with metastatic breast cancer (MBC). And it’s MBC, breast cancer that has traveled outside the breast to vital organs, that is responsible for the estimated 40,000 deaths this year from breast cancer.*** There is an urgent need for more more research that is focused on the specific needs of women living with advanced breast cancer. For example, specialized clinical trials are needed to determine the best drugs to use for patients with specific metastatic conditions or tumor characteristics or treatment responses.

Equality in Care: Many women in the United States diagnosed with breast cancer are not receiving treatment that meets what is considered to be the standard of care right now. More research is needed to fully understand the reasons for this. But there are steps that can be taken based on what we already know that will make an enormous difference. These include ensuring more widespread use of patient navigation programs, dedicated efforts to include broader participation across socioeconomic groups in clinical trials and ensuring adequate funding for programs at the state level that are designed to cover those in need.

Cost of Cancer Care: Financial toxicity has become one of the major adverse effects of cancer treatment. A huge part of this is the out-of-pocket costs to patients of cancer medications.  Experts are increasingly questioning the justification for the high prices of cancer medications, which can put beneficial treatment out of reach for some patients, even those with health insurance. For example, in a recent editorial, a group of 115 doctors said that the high prices of cancer drugs are affecting the care of patients with cancer.

Prevention: We’re  desperately in need of a 21st century screening methodology that can accurately identify pre-cancerous lesions, similar to what we do have for cervical cancer and colon cancer, so that we can intervene before invasive cancer develops. We also need research to understand how and to what extent harmful substances in the environment increase our risk for breast cancer–so that appropriate action can be taken to eliminate exposures to those substances. In addition, a safe and effective vaccine to be given to healthy women to prevent breast cancer could have enormous impact, and researchers with the National Breast Cancer Coalition’s Artemis Project are currently making progress toward such a vaccine.

These are some of the critical issues that need to be addressed. There are others of course, but I do think these are some of the big ones. Real progress is going to demand much more than the status quo.

What Can We Do That Would Make a Difference?

And what can each of us do? There are many things that we can do that will make a difference. Here are a few suggestions:

1. Become knowledgeable about issues like these that are holding back progress and talk about them with people you know. If you have a blog, write about these issues.
2. Let your legislative representatives know that issues such as continued strong investment in cancer research, ensuring equal access to care and addressing the high cost of cancer medications are important to you.
3. Donate some of your time or make a monetary contribution to a reputable breast cancer charitable organization, such as one that supports innovative approaches to cancer research or one that supports breast cancer patients in medically underserved populations.
4. Support the National Breast Cancer Coalition’s Breast Cancer Deadline 2020, which challenges policymakers, researchers and other stakeholders to work toward the goal of knowing how to end breast cancer by January 1, 2020.

*American Cancer Society, Cancer Facts & Figures, 2015
**American Cancer Society, Breast Cancer Facts & Figures, 2013-2014
***Metastatic Breast Cancer Network, 13 Facts Everyone Should Know about Metastatic Breast Cancer

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