The burden of breast cancer is rising worldwide, however, in 2020 it was the most common cancer,
overtaking lung cancer for the first time in decades. With 70% of cases, indeed, in countries of limited
resources, compare this to 60% in 2008. So it’s a 10% increment in the proportion of women affected
in countries of limited resources with a disproportionate increase in mortality. 60% of the mortality
attributed to breast cancer worldwide is indeed in countries of limited income compared to a 50%
proportion a decade ago. So it’s a rising problem and more important is the proportion of women
diagnosed at age younger than 50. 50% of women diagnosed with breast cancer in countries of
limited resources are younger than age 50, they are premenopausal, compared to less than 20% in
countries of high income. So that adds to the burden of breast cancer in these countries – those are
young women in the prime time of their lifetime, they are tending children, families, they are working
mums, working ladies, with a lot of burden and quite important for society, not only for their families. In
addition that’s another economic burden not only attributed to the woman, herself affected, and,
excuse me, men are affected as well but they are only 1% as compared to the total population of
patients with breast cancer, but also the family, the productivity loss of the family, the caregivers, the
family members tending to the woman during her treatment journey.
We always talk about early detection but the first priority is to address the rising trend for the burden
of breast cancer. The most widely cited reason is, indeed, westernising women’s risk. That has been
talked about for the past couple of decades but hasn’t been really highlighted in awareness
campaigns. We know that westernising women’s risk is really associated with desirable changes of
improving socioeconomic status, more control of her life but also it comes with a more sedentary
lifestyle, bad dietary habits or poor dietary habits, less breast feeding, more smoking and,
unfortunately, more drinking lately. All these increase the risk for pre- and postmenopausal breast
cancer and, indeed, you’d be surprised if I tell you the proportion of women with obesity, the highest
increase has been documented in countries of Africa, Southeast Asia and the Middle East, the same
countries where you have the highest rise in the incidence of breast cancer. We need to talk about
this in awareness campaigns and highlight it as a modifiable risk factor.
In addition to early detection, and I’m not talking about national screening mammography, I’m talking
about awareness about the importance of early detection, excellent outcome when it’s early detected
and limited morbidity of interventions when it’s detected early because women are more scared about
the intervention rather than the disease itself. Also quite important to talk about practical diagnostics.
We do not need to have everything in place before we address diagnostic mammography or at least
the status of the oestrogen receptor for a woman recently diagnosed with breast cancer which cannot
be, indeed, identified in some countries as we speak right now. We don’t need to have a perfect
radiology service in place, perfect pathology service in place, we need to tackle those factors that
could improve outcome with rapid diagnostics that are simple and affordable.
We need to address also certain elements of multidisciplinary care. We need to highlight the
importance of resource-stratified interventions. We need to talk about access to therapeutics - access
to therapeutics in terms of facilitating drug approval processes; in terms of pricing. But, very
important, access to therapeutics could be even improved in countries of limited resources through
access programmes and clinical trials. We need to talk about more clinical trials in countries of limited
resources, simply because they create excellent infrastructure to improve healthcare; they train health
personnel; they improve patient outcome; they actually cut down the cost and facilitate access to
excellent recent therapeutics at a minimum cost. For the global community they help facilitate
completion of trials in a cost-effective manner, also facilitate a quick approval for new options. In
addition, they verify the results in different ethnic groups and also teach us about drug metabolism in
different ethnic groups. That’s why addressing clinical trials, particularly those that are associated with
optimisation regimens or de-escalating regimens, are quite important in countries of limited resources.
They are being done in high income countries, I wonder why not talk about it in countries of limited
resources.
There will be a debate entitled Can we afford the price of recently approved targeted therapeutics in…
actually not only in countries of limited resources, it’s actually globally and that’s quite important
because we do have many new drugs approved lately, over the past couple of years. They make a
huge difference, they impact overall survival. Women with metastatic breast cancer these days could
survive potentially a median of five years, so up to ten years even with new therapeutics. But they will
not be able to survive that long without access to the drugs. They are priced at a very high cost, out of
reach for many women around the globe. Even in high income countries if they are not insured they
cannot access those so what’s the point of innovation if it can’t improve survival? That will be the
subject of the debate. It will be between Richard Sullivan and Alex Eniu and I very much look forward
to moderating this debate and for the discussion that would follow.
What do you think could be done about this?
You’d be surprised how many groups are trying to facilitate access to drugs around the globe. We
have many organisations, they have to be commended for what they’re doing. The Max Foundation
managed to get Gleevec, a drug that’s considered a miracle for patients with chronic myeloid
leukaemia, for 35,000 patients around the globe free of charge. Can you imagine? Remember,
chronic myeloid leukaemia is a rare disease so when I say 35,000 patients, and probably even more,
that’s a huge proportion of those patients. That’s Max Foundation by itself. We have ATOM and I
don’t want to forget other initiatives but we do have a lot of initiatives. Indeed, at ASCO this year, we
managed to convince so many of those groups together under an initiative for improving access to
oncology medications around the globe. So let’s hope for the future.