Last month, a friend asked me the impossible question: Of course, they knew the obvious - there's never a good time to have breast cancer. But they'd seen lots of recent headlines about advances in treatment and naturally assumed it would mean better outcomes for anyone being diagnosed today.
Unfortunately, it isn't that simple. What is clear, however, is that communications - one way or another - have a big influence on the lived experience.
In case you missed it, October 13 was metastatic breast cancer (mBC) awareness day, part of an annual month-long focus on breast cancer in general.
I always say this, but mBC deserves so much more than a one-day spotlight, perhaps a month. 10% of breast cancer cases are metastatic at diagnosis, while up to 30% of people with early-stage breast cancer will go on to develop metastatic disease. That's a lot of people. Right now, mBC is incurable, but it can also be treatable. As a result, many people with mBC aren't just living longer, they're living active and fulfilling lives (some for decades)... providing they can access the right medicine. Even then, there's no guarantee.
Probably the most overlooked barrier to better outcomes in mBC is poor communications. According to research, patients with breast cancer are less likely to stick to their treatment when their disease and/or side-effect profiles are not well-explained. A recent survey by the ABC Global Alliance and AstraZeneca reveals that many mBC patients are confused by information provided by their oncologists, in particular complex language around biomarkers. As a result, one in three patients living with mBC don't know what type of breast cancer they have, and this is damaging their confidence in understanding their diagnosis.
While innovation in science is limited to the genius few, communications are within our gift and play a crucial role in the management of mBC. Information must be tailored to individual needs and health literacy levels if we're to help patients and caregivers play an informed role in decisions about their care. According to the ABC Global Alliance: "Informed patients make the best advocates for themselves, but many lack the relevant education and support needed for self-advocacy." This is a big gap and an even bigger opportunity for our industry to make good on therapeutic advances.
Those advances keep on coming. Improvements in our molecular understanding of breast cancer have enabled us to classify the disease into distinct subtypes, and this has facilitated the development of more precise, more targeted, and, ultimately, more successful therapies. Many have come to the fore this year.
The past six months have seen an expanding range of new treatment options and an array of impressive gains. These include improvements in overall survival - ie people live longer - in patients with advanced triple-negative breast cancer; better progression-free survival (PFS) in HER2-positive mBC, including those with brain metastases; and improved PFS in hormone-receptor-positive HER2-negative, HER2-low and HER2-ultralow mBC. And there's more around the corner, including strong prospects of a triple combination treatment option that reduces the risk of progression or death in patients with PIK3CA-mutated hormone receptor-positive HER2-negative mBC.
Advances in testing and medical imaging are accelerating too. The growing adoption of genetic and biomarker testing is informing treatment decisions that align with recognized subtypes. Meanwhile, the increased use of AI in imaging is helping to drive earlier diagnoses typically associated with better prognosis, better treatment options and better survival rates. And in the US, new guidelines on breast cancer screening - which lower the recommended age to begin regular mammograms from 50 to 40 - are bolstering efforts to catch breast cancer earlier.
Everything is pointing in the right direction, so why shouldn't we expect an uptick in outcomes for people being diagnosed today? There are three reasons to temper expectations.
The first is rooted in science itself. Science, by definition, is not a magic locker of absolute truths, it's a constant process of learning and discovery. Sure, our understanding of breast cancer is deepening, but there's so much more we do not know. We see this every day when patients with a subtype of breast cancer proven to respond to a particular therapy suddenly veer off the anticipated pathway, and we don't know why. Our bodies are complex and medicine isn't an exact science.
When breakthrough studies are unveiled at the big cancer congresses, it's easy to get dazzled by impressive response rates that promise a revolution in outcomes. But we must remember that, however large the percentages, real-world practice always comes down to just one person: the patient. And that patient may not respond in the way the science predicted. Outcomes are never guaranteed, no matter how good the science is. That's why we must always keep pushing to learn more.
Another factor is health inequity. Gaps in cancer care are a global issue, leading to the awful reality that where you live can determine if you live. In breast cancer those disparities are significant. For example, in developing countries, 80% of new breast cancer cases are diagnosed at the metastatic stage, with obvious consequences. Similarly, in more developed nations, access to screening services or life-extending treatments can be restricted and uneven. Innovative medicines only improve outcomes if you can access them.
The third reason, as discussed, is communications. It can, and does, make a difference to lives.
And so, we circle back to that impossible question: is it better to have been diagnosed with breast cancer this year rather than last? The answer, in theory, is 'yes, it should be.' But, beyond the science, optimal outcomes depend on three essential factors:
We've got plenty to do.