Ambassador Brinker, it’s great to see you, especially as your work with the World Health Organisation, that’s the ambassador, your present one, you’ve been other ambassadors in the past. But you’re involved with the World Breast Cancer Report, just fill me in very briefly on what this is, first of all, because I want to ask you why you did it.
Well, my principle role in life is founder and CEO of Susan G Komen for the Cure, which is the largest breast cancer organisation now in the world, so named after my sister, Susan Komen, who died in 1980 who was only 36 at the time and asked me if I would do something, do anything I could, to cure this disease. Of course, she didn’t just mean funding the most amount of research, which we do, we’re the largest private funder of breast cancer research, but also the clinical care. Also we realised a very, very long time ago, 32 years ago, 34 years ago, when she was being treated that where a woman lives or how much money she has shouldn’t determine whether she lives. That’s really the seed of this report. You will see as Peter goes through it what some of the issues are and they all point back to disparities. But a different kind of information: many years ago the prevailing thought was that breast cancer was a disease that really was only of importance in communities and countries that were considered rich and women who were well fed and developed breast cancer and that that was where the problems was, not in lower resource populations. This report basically turns that upside down because many, many people contributed to this and Susan Komen, our organisation, felt it was extremely important to do a report like this, to gather the information, because things have changed dramatically. Breast cancer is proliferating in low resource countries and it is extremely important for us now to attend to the disparities we know that exist between populations.
It’s thanks to your sister that we have this report now and your work stemming from it. This priority is both within countries and internationally. What are the key effects of those disparities at the moment?
It’s very clear that if people aren’t treated in the same way, after all we have a lot of information today, a lot of treatment, much of it totally unavailable to women in lower resource countries. But when we can even out the field, when we can provide care and we can do the right things for people with this disease and diagnose it very early, we can create similar outcomes. So it shows that if you treat people the same way, no matter what their background, what their population or what their income level, the survival rate will be very similar.
There are controversies though, aren’t there? We’ve been hearing some controversies here at the meeting in Lyon. It’s not fully agreed where the money should be spent or where the resources should be allocated. What’s your take on this?
My take on it is two things. First of all we’ll never all agree on what part of the system we should spend money on but I will tell you what I think we all agree upon and that is that this disease, from what we know now, needs to be detected early. When that happens, and it’s not just the detection of the disease, it’s not just screening a woman, it is taking care of the barriers to care early. Particularly when you have a low resource woman who has no psychosocial support in most cases and no patient navigation, no-one teaching her about what this disease will present to her, what the clinic means, what the treatment means, then when we provide things like some short-term childcare while she’s being treated, transportation is a major issue, whether it’s in the United States or whether it’s in… particularly in places in Africa where women live in villages far removed from any kind of treatment. So there are issues about that and so there are a great many issues but we do know that if we do some of these things early and we can get to people, and, again, there is not universal treatment, it’s very difficult to screen and find out you have the disease and then have nowhere to send the woman. However, we do know one thing: the earlier the better.
We have learned recently that there are disparities in outcomes because of the availability of treatment. What are the key priorities, in your opinion, for getting things right so that women get the right treatment, get to the right centre at the right time, even in resource poor settings?
Well one of our answers to what one of the projects that we’re working on that we believe very, very strongly in, you will hear Brian Hook, our senior global advisor, discuss it later on in an interview you’re going to be doing. We’ve thought about this problem for a long time. In global health we just can’t have silos of care, individual cancer centres in places. We don’t have the funding and the time and the interest to do that sort of care; it’s just not possible. But it’s even more than that – we need to be treating many diseases across the platform, for example communicable diseases, HIV/AIDS is a good starter. We noticed, when I was travelling with the President and was in Tanzania we visited a PEPFAR clinic and I saw all the women and their babies standing outside waiting to come into this clinic which was screening them for HIV or treating them for HIV/AIDS, in some cases TB and malaria. I thought to myself, ‘Why aren’t we screening them for cervical cancer, it’s rampant here?’ and then, from there, we could move in to breast education, we could teach them about breast cancer. After all, to just assume that people living in these countries don’t know a disease like breast cancer exists is foolish. We hear from these people all the time on our website, either they have a mobile device or somehow they get to a desktop computer or some way, we don’t know how they reach us. They know care is there and we need to make sure that we make it available.
Interestingly enough, Tanzania is one of the places where the cervical cancer vaccine has been pioneered so clearly some of those settings are absolutely prime places for doing a whole lot of things.
Yes, and it’s all connected. We’re a body of many parts and we do believe in a continuum of care, not just in how we treat a disease like breast cancer but what happens to a woman from the time she is born, what sort of risk does she face? So that, yes, it’s getting the vaccine but then what happens after that? What happens with her reproductive issues as she becomes a young woman? What happens with gestational issues? What happens as she becomes a middle-aged woman? Diseases like breast cancer are frequent. So we’re trying to approach it that way too.
I can see that you’re a person with a mission and obviously this could be very open-ended, but how would you narrow it down to the key things that you would like to see done in the very near future?
What I like is measurement. Everything, I like to see everything we do have metrics to it, outcomes where we know exactly is it working. In the kind of programmes we’re doing we can carefully measure, we have careful goals and we’re measuring against them to see if what we suspect is real and so far we believe it is.
Nancy Brinker, it’s a treat to talk with you. Thank you for joining us on ecancer.tv.
Thank you, thank you for having me.
