A Road Map for Change Report Provides a Guide to Elevate Breast Cancer Care

An inclusive road map for change laid out in the Lancet Breast Cancer Commission report, walking through 6 themes to address challenges in the field, marks an important step toward eradicating existing equity gaps.1 The evidence-based plan, grounded in raising awareness for the many individuals living with metastatic breast cancer who have gone unaccounted for, was designed for all who are connected to breast cancer, but directed at policy makers. The report includes indicators of progress and highlights inequities in prevention, detection, treatment, and supportive care through its 6 pillars: prevent, personalize, include, collaborate, identify, and communicate (Figure).1,2

“Some of the most exciting developments of 2024 came from the Lancet Breast Cancer Commission,” Reshma Jagsi, MD, DPhil, coauthor of the report, said in an interview with OncologyLive. “The theme that I was most actively involved in was the theme [6] on patient empowerment and communication. We focused on trying to ensure that we support decisions with all the information that’s available and make sure that the wonderful research that’s being done in randomized trials gets to patients. [This is key] so that patients can reflect on the evidence and consider all the options that they have and make decisions that are concordant with their own values and preferences.”

In addition to emphasizing the importance of empowering patients by ensuring they are at the heart of clinical communication, another theme of the report focused on personalizing treatment.3 The commission noted that health systems and clinicians should personalize care and that embracing digital technology in an equitable manner can reduce barriers, aid in connecting with patients who are hard to reach, and increase diversity and inclusion in clinical studies. Tying into the aforementioned themes is the theme of collaboration, which the report cited as key to closing the equity gap through global early diagnosis, treatment frameworks, and innovative technology.

“This commission brought together investigators from all over the globe who are continuing to collaborate and trying to build on this work to take the insights and the lessons that are in the report forward,” Jagsi said. “I [was] excited about opportunities to connect at the 2024 San Antonio Breast Cancer Symposium [SABCS] and the Miami Breast Cancer Conference® and beyond with not only the collaborators on that report, but with the populations they represent.”

Discussions on the report’s findings at SABCS preceded those that will occur at the 42nd Annual Miami Breast Cancer Conference hosted by Physicians’ Education Resource®, LLC.4 Jagsi is serving as cochair of the multidisciplinary meeting in March 2025 in Florida.5

“The chair of the report, Charlotte E. Coles,PhD, MRCP, FRCR, is going to be joining us as a speaker,” Jagsi noted. “And Felicia Knaul, PhD, a health economist and advocate will be delivering a keynote talk.”

A Call to Action for High-Quality Registry Data on Metastatic Disease

Breast cancer is now the most common cancer in the world and data revealed that at the end of 2020, 7.8 million women had been diagnosed with the disease in the past 5 years.1 However, it is unknown how many people are living with metastatic breast cancer because many cancer registries do not record data on relapses, which has created a large gap in knowledge.

“Much of The Lancet Breast Cancer Commission report was focused on groups [of patients] who have been ignored or forgotten, and another key theme was how patients with metastatic disease have not gotten the attention that they should have,” Jagsi explained. “We don’t even have accurate information on the prevalence of metastatic disease because registries don’t collect rigorous information on this.”

Therefore, the report called for high-quality data to be collected on cancer relapses worldwide and to identify patients with metastatic cancers in general, in addition to breast cancer. With this, the committee also suggested raising awareness and educating stakeholders/society to address the stigma around metastatic breast cancer and noted that the equitable implementation of global early detection, treatment frameworks, and innovative technologies via collaboration will aid in closing the equity gap in care and outcomes.1

“With adequate resources and a shift in attitudes, it might be possible to cure some people, treat most, alleviate the suffering of all, and abandon no one,” the Lancet Breast Cancer Commission wrote regarding patients with metastatic disease.

“That was a beautiful part of the report,” Jagsi noted, adding that, “We [also] use language in ways that sometimes is very unfortunate. We’ll talk about a patient having ‘failed,’ and of course the patient hasn’t failed—we have failed to control the disease in the patient.”

Changes in language and communication represent another needed next step to push the breast cancer field forward and elevate care for all.

Examining the Rising Incidence of Disease and Hidden Costs of Breast Cancer

Breast cancer incidence rates are expected to rise and countries with a low Human Development Index (HDI) are predicted to see a doubling of new diagnoses and deaths by 2040. Additionally, incidence and mortality rates are expected to increase by 70% and 60%, respectively, in countries with a medium HDI. By 2040, more than 3 million new diagnoses—an increase of 40% from 2020—and more than 1 million deaths—an increase of 50% from 2020—are anticipated per year.

“The incidence of breast cancer is now projected to reach more than 3 million [people] per year by 2040, and patients in low- and middle-income countries will be the hardest hit,” Jagsi said. “Prevention is essential, and there was also a focus on the hidden costs and suffering that are burdens that come with breast cancer [in the report as well], including the financial, physical, psychological, emotional, and social tolls of this disease.”

To address the hidden costs associated with breast cancer, the commission has called for the development of new, validated tools to record costs and suffering experienced by patients with breast cancer as well as their caregivers and families; the commission also asked for the development of metrics to measure the benefits that are placed on alleviating suffering related to breast cancer. They noted that the novel tools may influence policy makers to determine new priorities to ensure that there is financial protection, and that supportive and palliative care is available at every stage for patients with breast cancer. To calculate the true cost of breast cancer to societies and identify the costs, the report suggested more systematic monitoring of family income loss, cost-related nonadherence, treatment withdrawal, and quality of life. The report also emphasized that exposing and reducing costs could provide policy makers with an incentive to invest in prevention, early detection, cost-effective therapies, and the optimal management of breast cancer.

The report added that “with the Lancet Commission on Cancer and Health Systems, the Lancet Breast Cancer Commission initiated a collaboration with partners in several countries to generate country-level, context-relevant costs and cost burden data to better inform priority setting on a health care system level for cancer control.” Additionally, it was highlighted that the Costs and Supportive Care in Breast Cancer study has conducted exploratory pilot research in the UK as the country has universal health coverage for cancer care via the National Health Service.

The Path to Promoting Equal Progress

Furthermore, the report detailed how the advancements made in breast cancer beginning in the early 1990s have not been equal for all. Changes made regarding diagnoses and coordinated multidisciplinary evidence-based treatments have resulted in a decline in breast cancer mortality rates by approximately 2% each year, translating to a 40% reduction over more than 30 years in breast cancer age-standardized mortality rates. However, patients in low- and middle-income countries do not experience the same survival rates as others due to diagnoses being made when the disease is at an advanced stage and low diagnostic and treatment capacities. Data showed that 5-year breast cancer survival rates are greater than 90% in high-income countries whereas rates are 66% in India and 40% in South Africa. Approaches tailored to local communities that have worked well in high-income countries where fewer resources are available is a necessary next step to address this disparity, according to the report.1

In the full report, the Lancet Breast Cancer Commission outlined approaches for changes amongst each theme cited, key messages, risk factors, and more.

“This report was a tour de force, and it provides a road map of communication, inclusion, prevention, collaboration, and personalization,” Jagsi said. “It’s important to emphasize that this [report] is not a one-and-done endeavor—it is the foundation for so much collaborative work that we must push forward together.”

References

1. Coles CE, Earl H, Anderson BO, et al; Lancet Breast Cancer Commission. The Lancet Breast Cancer Commission. Lancet. 2024;403(10439):1895-1950. doi:10.1016/S0140-6736(24)00747-5
2. The Lancet Commission on Breast Cancer publishes recommendations for change. Cancer Research UK. April 16, 2024. Accessed December 5, 2024. bit.ly/3ZDaxpP
3. The Lancet Breast Cancer Commission. Infographics. April 15, 2024. Accessed December 5, 2024. bit.ly/41lFLDh
4. 42nd Annual Miami Breast Cancer Conference. Physicians’ Education Resource, LLC. Accessed December 5, 2024. bit.ly/4iiv8qN
5. San Antonio Breast Cancer Symposium. Full program. Updated November 20, 2024. Accessed December 5, 2024. bit.ly/3ZqlWrV