Report: U.S. has made little progress toward ending breast cancer

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In its first annual "Breast Cancer Deadline 2020 Progress Report," the National Breast Cancer Coalition (NBCC) cited minimal progress toward ending the disease. To achieve its goal of ending breast cancer by Jan. 1, 2020, the organization advocates a two-pronged approach to research: determining the causes of and methods to prevent breast cancer metastasis and preventing breast cancer from developing in the first place.

Although the U.S. invests more than $1 billion dollars annually in breast cancer research, progress toward ending the disease has been slow, Washington, D.C.-based NBCC stated. Despite years of awareness campaigns and widespread screening, the incidence of late stage breast cancer has not changed since 1975.

“If we are serious about ending breast cancer we must first understand the reality of the disease at every level,” said NBCC President Fran Visco. “This baseline report provides a snapshot of the current state of breast cancer, with an overview of breast cancer trends, research advocacy, and public policy, and the advocate perspective on the barriers that have hindered progress.” The report concluded with the framework for how NBCC intends to ensure meaningful progress toward ending the disease in the next nine years.

Five-year survival statistics have been used to paint an unrealistic picture of the disease, according to the report. Although the National Cancer Institute (NCI) reports five-year survival from early breast cancer at 98 percent, this does not reflect the real experience of people with breast cancer.

The report noted that within that figure are many women with metastatic disease, and women who will recur and be diagnosed with metastatic disease in the future. They will not be survivors. This number also includes women who never would have had a life-threatening type of breast cancer.

The report made several key points, including:
  • Not all breast cancers are the same. Though physicians have known for some time that some breast cancers express excess estrogen receptors, they now know that there are several types of breast cancer based on the biology of the tumors. These different subtypes of breast cancer behave differently, are associated with different populations of women and different risk factors, and may have different causes. These subtypes respond to different treatments and have different prognoses.
  • NCI gathers information on the incidence of breast cancer by race and age, but not by subtype of disease. In the U.S., the age-adjusted incidence rate for invasive breast cancer for all races was 122.9 per 100,000 women per year in 2003 to 2007. The median age at diagnosis was 61 years of age, with the most diagnoses occurring between ages 55 and 64.
  • Because of increased screening beginning in 1980, there has been a dramatic increase in the incidence of precancerous ductal carcinoma in situ (DCIS).  Most DCIS will not become invasive breast cancer, but physicians do not yet know how to distinguish which will; therefore all women with DCIS receive treatment similar to treatment for early breast cancer.
  • In the U.S., while overall incidence has fluctuated over the years, the incidence of women diagnosed with advanced breast cancer has not. Rates of diagnoses of breast cancer that has metastasized have remained stable since 1975.
  • Between 1987 and 2000, mammography screening of healthy populations of women more than doubled in the U.S., but has remained relatively stable and decreased slightly in recent years. The evidence of a mortality reduction from screening is conflicting and continues to be questioned by some scientists, policymakers and members of the public. The analyses to date of all randomized controlled trials for mammography have concluded marginal benefit. The reality is that many of the tumors that are found “early” would not have become life-threatening metastatic cancers, and some of the treatments for these early cancers have life-threatening side effects.
  • Women do not die of primary breast cancer. More than 90 percent of breast cancer deaths are due to the spread of the disease to other parts of the body, such as bone, lungs and the brain. Approximately 155,000 women are living with metastatic breast cancer in the U.S. and this is projected to rise to 162,000 by the end of 2011, according to one expert cited in the report.
  • For decades, breast cancer treatment has included surgery, radiation therapy, chemotherapy, and/or hormonal therapy, and within the past 15 years, targeted therapy. Much of the recent progress in treatment has been in doing less.
  • There has been some progress toward developing treatment targeted to different subtypes, but the majority of women with breast cancer still receive the same treatment.

The current infrastructure and focus in breast cancer has not led to significant progress in ending the disease or in preventing deaths from the disease, according to NBCC. This is true for research and healthcare and also advocacy: more of the same will not produce different results, the organization asserted.

NBCC advocates have a new approach to change the conversation and to answer key questions in breast cancer to ultimately end the disease by Jan. 1, 2020. The plan is to disrupt the status quo on all fronts with the sole purpose of directing attention and resources to achieve Breast Cancer Deadline 2020. The majority of breast cancer research focuses on finding the next treatment drug. NBCC emphasized its focus on two issues: determining the causes of and how to prevent breast cancer metastasis and preventing the disease from developing in the first place.