The Lancet Breast Cancer Commission has unveiled a groundbreaking roadmap for transforming global breast cancer care, presenting an evidence-based framework structured around six fundamental themes: prevent, personalize, include, collaborate, identify, and communicate. This comprehensive initiative aims to address significant inequities in prevention, detection, treatment, and supportive care worldwide.
Global Impact and Rising Challenges
Breast cancer has emerged as the world's most prevalent cancer, with 7.8 million women diagnosed in the past five years as of 2020. The outlook is particularly concerning, with projections indicating global cases will surpass 3 million annually by 2040 - a 40% increase from 2020. Low and middle-income countries face the most severe impact, with predictions suggesting a doubling of new diagnoses and deaths by 2040 in regions with low Human Development Index (HDI).
"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," explains Dr. Reshma Jagsi, MD, DPhil, a coauthor of the report.
Addressing Critical Gaps in Metastatic Disease Tracking
A significant finding of the commission reveals a crucial gap in knowledge regarding metastatic breast cancer prevalence. Current cancer registries often fail to track disease relapses, creating substantial blind spots in understanding the full scope of advanced disease. The commission strongly advocates for implementing high-quality data collection systems for cancer relapses worldwide.
"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," notes Dr. Jagsi.
Hidden Costs and Healthcare Disparities
The commission emphasizes the need to address the often-overlooked costs associated with breast cancer, including financial, physical, psychological, emotional, and social burdens. The report calls for developing new tools to measure these impacts on patients, caregivers, and families, while also tracking metrics related to family income loss, treatment adherence, and quality of life.
The disparities in care access and outcomes are stark: while high-income countries report 5-year breast cancer survival rates exceeding 90%, the rates drop to 66% in India and 40% in South Africa. These differences largely stem from later-stage diagnoses and limited diagnostic and treatment capabilities in resource-constrained settings.
Patient-Centered Communication and Care
The commission places significant emphasis on patient empowerment and effective 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," Dr. Jagsi explains.
The report also advocates for personalizing care through digital technology adoption, which can help reduce barriers and increase diversity in clinical studies. However, the commission emphasizes that such technological implementation must be done equitably to avoid exacerbating existing disparities.
Moving Forward
The commission's work represents a foundation for ongoing collaborative efforts to improve breast cancer care globally. As Dr. Jagsi concludes, "This report was a tour de force, and it provides a road map of communication, inclusion, prevention, collaboration, and personalization. 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."
