Tackling global breast cancer threat

Claire Goodliffe

A lack of consumer understanding about breast cancer and the benefits of early detection and screening is putting lives at risk. The recent flurry of pink ribbon campaigns to mark Breast Cancer Awareness Month in October reminded me that we need to do even more to promote the benefits of early detection if we are to tackle this disease. In the future, as more women survive the disease, we also need to shift our focus to helping improve survivors’ quality of life.

Recently, there have been controversies about the benefits, harms and cost-effectiveness of secondary breast cancer prevention measures (the principal form of which is population-based mammography), with some arguing that it leads to overdiagnosis, causing unnecessary treatment costs as well as risks and worries for affected women.

However, the findings from a recent study commissioned by GE Healthcare and authored by Bengt Jonsson, professor in health economics at the Stockholm School of Economics, and Nils Wilking, associate professor at the Karolinska Institute, provide further evidence as to why early detection and treatment is critical to tackling the disease.

The report, which investigates the impact of the disease globally, also highlights that early detection is key to tackling breast cancer in both the developing and developed world, despite disparate trends in breast cancer incidence and mortality rates in these regions.

Rising breast cancer incidence and high mortality rates represent a significant and growing threat for the developing world in particular.

This is mainly due to increases in life expectancy as well as lifestyle changes, such as women having fewer children, and hormonal interventions such as post-menopausal hormonal therapy.

In these regions, Jonsson and Wilking’s report suggests that a lack of consumer understanding about breast cancer and the benefits of early detection and screening is putting lives at risk.

Women in newly industrialized countries are often reluctant to get checked for breast cancer until it is too late. Reasons for this include a lack of awareness and information. For example, a recent survey in Mexico City indicated that many women feel uncomfortable or worried about having a mammogram. Another recent study found that among 1,000 Hong Kong-Chinese women aged between 18 and 29, almost 60 percent had never heard of mammography screening.

Innovative programs such as those being piloted by the Saudi Ministry of Health, in partnership with GE Healthcare, are needed to tackle the problem. The initiative focuses on improving access and timely diagnosis of breast cancer to help address the fact that nearly 70 percent of women diagnosed with the disease are already at an advanced stage by the time they visit the doctor. To help overcome cultural barriers that are preventing women from wanting to test for the disease, mobile units equipped with mammography machines are being used to raise awareness of the benefits of breast cancer screening within the heart of the community. A specialized call center for women to schedule appointments and get more information on the disease has also been established.

Key outcomes for phase 1 of the launch include screening being well-received by the Saudi population and mobile clinics being better utilized when located within the community, rather than primary health care centers.

Jonsson and Wilking’s report also makes clear the benefits of early detection of breast cancer in developed countries.

The report highlights that according to the most recent published data, 15 million years of “healthy life” were lost worldwide due to women dying early or being ill with the disease, in 2008. However, with more women surviving the disease in the developed world, there is a growing issue around women being incapacitated by the effects of living with breast cancer.

Here, the benefits of early detection are twofold. From a patient perspective, an important benefit of detecting and diagnosing breast cancer early is that it can avoid the use of complex, costly and invasive interventions. In addition, early detection, followed by timely treatment, can increase the range of treatment options available to a patient, such as the opportunity for breast-conserving therapy.

There are also economic benefits. Several studies have consistently found that treatment costs for the later stages (stage 3 and 4) are higher than for the treatment of breast cancer in stage 1 and 2.

Jonsson and Wilking’s report provides welcome evidence of the need for early detection and treatment of breast cancer. As a result, it is clear there is a need to increase knowledge in two areas to improve survival rates further and address the growing issue of breast cancer survivors having poor quality of life.

First, we need to collect more data around breast cancer incidence and mortality, the economic burden of the disease, and detailed patient-linked data on the outcomes in relation to treatment patterns and diagnosis.

Stipulating that every country has national cancer registries to gather vital statistical information on breast cancer will help ensure we continue making progress in tackling the global burden of this disease.

Second, we need to do even more to raise awareness of breast cancer. Studies suggest that women being aware of the value of early detection is an important element of early diagnosis.

We need more than a month to focus on breast cancer, and we need to be raising awareness about it all the time.

*The author is the global oncology director for GE Healthcare.

by Claire Goodliffe