Landmark Global Decade Report reveals breakthroughs in advanced breast cancer but exposes a widening global equity gap
Associação Advanced Breast Cancer Global Alliance
image:
Fatima Cardoso
view moreCredit: ABC Global Alliance
Lisbon, Portugal: The ABC Global Alliance today launched the Advanced Breast Cancer (ABC) Global Decade Report 2015–2025 — a landmark global assessment revealing a decade of remarkable scientific progress that has transformed ABC care for some patients in some countries, while many others around the world have yet to benefit.
The results expose profound and persistent inequalities that leave many patients behind. The report’s central theme, ‘Knowledge in Motion’, emphasises the urgent need to translate a decade of evidence and innovation into life-changing action for every person living with ABC.
These compelling findings drove the creation of the ABC Global Charter 2025–2035, which is also launched by the ABC Global Alliance today at the Advanced Breast Cancer Eighth International Consensus Conference (ABC8). The Charter sets out new ten-year roadmap to drive equitable progress and transform care for everyone with ABC, regardless of where they live, their cancer subtype, or their socioeconomic status. The report and global charter are published simultaneously today (Thursday) in The Breast. [1]
A decade of progress and persistent gaps
The report confirms that collective action over the past decade has yielded significant advances in ABC care, proving that progress is possible:
- The assumption that ABC is a rapid death sentence, and that money spent treating it is wasted, has been proven wrong. The five-year median overall survival rate for women with ABC has risen to 33%, up from 26% a decade ago, with real-world data showing median survival for HER2+ disease exceeding 50 months in some regions.
- The first truly international consensus guidelines for the management of ABC have been embedded in practice across multiple regions.
- New ways of connecting data have provided the first reliable ABC prevalence estimates (an estimate of the number of people living with ABC) in countries like Australia and Northern Ireland.
- Conversations around quality of life, stigma, workplace rights and psychological support have moved closer to the centre of global and national cancer policy.
Nevertheless, the uneven distribution of progress has only widened the gap between what is possible and what remains the reality for the majority of patients.
- Median overall survival for triple-negative ABC has increased by less than three months in the past decade, remaining at just 13 months.
- Disparities in access to biological or targeted therapies persist globally, with drugs such as trastuzumab — which for the last two decades has been the mainstay treatment for HER2+ ABC — is available in only 51% of low-middle income countries versus 93% of high-income countries.
- Over half of all people with ABC (55%) report that they have never been offered any support services by their healthcare team.
- While some laws and workplace protections exist, no country has effectively implemented a comprehensive legal framework to fully protect the working rights of people with ABC and their informal caregivers.
Dr Fatima Cardoso, medical oncologist and President of the ABC Global Alliance, said: “This report shows what a decade of collective action can achieve, proving that progress isn’t theoretical – it transforms lives. Yet progress is not the same as equity. Our challenge and commitment is to close the gaps in ABC care within and between countries.”
The human cost of inequity: a call to action for the next decade
The report draws on two global surveys conducted in 2024, including responses from 1,254 people with ABC across 59 countries and 461 healthcare professionals across 78 countries, both revealing the profound burden of ABC:
- Quality of life and psychosocial needs remain unmet:
- 79% of patients report that ABC has a negative impact on their emotional and psychological wellbeing.
- Only 53% of healthcare providers report regularly referring patients to psychological support services.
- Access to innovative care is limited:
- 79% of people with ABC report never having participated in a clinical trial, a critical pathway for access to treatments.
- High out-of-pocket costs are a global issue, with 60% of patients reporting a negative impact of ABC on their financial security.
- Stigma and isolation remain pervasive:
- Nearly half of people with ABC (47%) report that others do not understand their situation, leading to feelings of isolation which can impact a person’s quality of life.
- Workplace rights remain unprotected in many countries:
- 73% of people with ABC say the disease negatively affects their ability to work or study, with many facing a lack of support, difficulty returning to work, or job loss.
Dr Cardoso said: "This landmark global report marks a pivotal moment. We've proved that progress is possible, and now we must evolve our expectations to meet patients' needs today. This new charter is grounded in evidence, driven by the urgent need to turn proven potential into standard practice for all patients, in all regions, in all circumstances. Our ambition is to ensure that every person living with ABC has the chance to live as well as possible, for as long as possible – not just those in wealthy nations or with specific subtypes."
Looking to the future: The ABC Global Charter 2025–2035
To address these urgent challenges, the new ABC Global Charter sets ten ambitious, measurable goals for the next decade, from ensuring high-quality data collection and registry standards, to improving the legal and workplace rights for patients and their informal caregivers.
ABC Global Charter 2025–2035: ten key goals
- Further improve survival in people with ABC by doubling median overall survival
- Optimise care and outcomes for people with ABC by collecting high-quality data
- Improve the quality of life of people with ABC
- Ensure that every person with ABC is treated and cared for by a specialised multidisciplinary team according to high-quality guidelines
- Improve communication between healthcare professionals and people with ABC and their caregivers
- Meet the information needs of all people with ABC
- Ensure all people with ABC have access to comprehensive, person-centred support services
- Reduce misconceptions, stigma and isolation by improving understanding of ABC
- Improve access to comprehensive care for people with ABC, regardless of their ability to pay
- Improve the legal rights of people with ABC, including the right to continue or return to work.
Journal
The Breast
Method of Research
Observational study
Subject of Research
People
Advanced breast cancer patients living longer thanks to improvements in treatment and care
Associação Advanced Breast Cancer Global Alliance
Lisbon, Portugal: People diagnosed with advanced breast cancer in 2025 can expect to live for an extra six or seven months, compared to the average survival time for patients diagnosed in 2011, according to a major study of patient data in the US presented at the Advanced Breast Cancer Eighth International Consensus Conference (ABC8). [1]
For some types of advanced breast cancer, the average improvement in survival is ten months or more; however, the data also show a smaller increase in survival for so-called triple negative advanced breast cancer.
Researchers say the increase in survival time coincides with the availability of more effective treatments for advanced breast cancer, as well as wider improvements in diagnosis and quality of care.
The research was led by Professor Fatima Cardoso, President of the Advanced Breast Cancer Global Alliance (ABC Global Alliance), Lisbon, Portugal, and Dr Thibaut Sanglier, Senior Principal Data Scientist at F. Hoffmann-La Roche, Basel, Switzerland.
Professor Cardoso said: “Survival time for patients with advanced breast cancer, where the cancer has spread to other parts of the body, is much lower compared to early breast cancer. The major treatments for this stage of breast cancer are systemic therapies, like hormone therapy, chemotherapy and targeted therapy, that aim to kill cancer cells wherever they are growing in the body.
“In the last 15 years, we have seen a number of new systemic therapies developed and become available to some patients. We wanted to take a look at whether improvements in treatment are making a real difference to survival time for patients, and whether some groups of patients are doing better or worse than others.”
The study included more than 60,000 patients who were treated for metastatic breast cancer in the US since 2011. Researchers broke the data down into blocks of three years, so they could compare average survival over time.
They also broke the data down into the main subtypes of breast cancer according to whether or not the tumours are fuelled through the human epidermal growth factor receptor 2 (HER2+) and whether the tumours are fuelled through the oestrogen and progesterone hormone receptors (HR+). Triple-negative breast cancers are tumours that do not have any of these receptors (HER2, or oestrogen or progesterone receptors).
Overall, the average survival for patients who began systemic treatment between 2011 and 2013, was 27.5 months. This increased over the following years and, for patients who began treatment between 2020 and 2022, average survival time increased to 34.3 months.
Patients with HER2+/HR+ advanced breast cancer had the longest survival times at the start of the study period (42 months on average), and this continued to improve over the following years (53.1 months by end of the study period). In patients with HER2+/HR- cancers, the improvement in survival time has been greater (33.4 months to 52 months), especially after 2014-2016.
Survival times for patients with HER2-/HR+ have increased more gradually from 31.7 months to 39.2 months.
Survival time at the start of the study period was lowest for patients with triple negative breast cancer (11.2 months). This remained low for most of the study period, but has improved modestly for patients who began treatment in 2020-2022 (13.2 months).
Professor Cardoso said: “Alongside improvements in diagnosis and quality of care for patients with advanced breast cancer, we’ve seen several new treatments targeted towards breast cancer in recent years. Examples are the treatments targeting the HER2 receptor, that have changed the natural history of this subtype of breast cancer, and a group of medicines called CDK4/6 inhibitors for the hormonal-dependent breast cancer subtype.
“More recently, some much-needed new therapies for triple negative breast cancer, such as immune checkpoint inhibitors, PARP inhibitors and antibody-drug conjugates, have been developed and approved. We expect that their positive effect on survival will become more visible in the next few years.
“We knew that some of these treatments prolong life for patients treated in clinical trials, but this study suggests that they are also effective in ‘real-world’ patients who can access them, with important improvements in survival. The survival improvements seen in this study are likely to be similar in other high-income countries, where innovative therapies are available. However, a major hurdle is the cost of all these agents, rendering them unaffordable to many patients worldwide. One of the findings of the new ABC Global Decade Report 2015-2025 is that inequalities, between and within countries, have increased in the last decade.
Professor Eric P. Winer is an Honorary Chair of ABC8 and Director of the Yale Cancer Center, USA, and was not involved in the research. He said: “These results are positive for people who are being diagnosed with advanced breast cancer today; they can expect to live longer, compared to patients diagnosed ten or even five years ago. However, results have improved more for some types of breast cancer than others, and we still have a tremendous amount of work ahead. The outcome for many patients, such as those with triple negative breast cancer, is still highly variable.
“It’s important to say that these are patients treated in the United States, where patients often have better access to some of the newest therapies. This study shows that research and development of new treatments can make a real difference to patients’ lives. Now we need to make sure that advanced breast cancer patients can access and benefit from these treatments wherever they are in the world.”
Method of Research
Observational study
Subject of Research
People
First global survey highlights challenges faced by young women with advanced breast cancer
Nearly half have children aged under 18 years, and many experience hardship
image:
Jennifer Merschdorf, chief executive officer of Young Survival Coalition
view moreCredit: Jennifer Merschdorf
Lisbon, Portugal: Nearly half of all women aged younger than 40 who live with advanced breast cancer have children under the age of 18, according to the first global survey to investigate the challenges these women face. Results from the survey were presented to the Advanced Breast Cancer Eighth International Consensus Conference (ABC8) today (Thursday). [1]
Jennifer Merschdorf, chief executive officer of Young Survival Coalition, which conducted the Project 528 survey, told the conference: “We launched Project 528 to fill a critical gap – the voices of young adults living with advanced breast cancer are often under-represented in clinical discussions and policy dialogues.
“For the first time, we now have global data that reflect the voices of young women with advanced breast cancer. This survey gives us the evidence we need to understand their unique challenges and to ensure that research, services and policies are shaped by their lived experiences – not by assumptions.”
Of 3,881 women living in 67 different countries around the world who responded to the survey, 385 were under the age of 40 and living with advanced breast cancer. Results presented today relate to these younger women.
They showed that, in addition to the 48% of women with young children, 64% said their employment had been disrupted after they were diagnosed with advanced breast cancer (ABC), 40% incurred medical debts and their financial security plummeted from 51% before diagnosis, to just 3% after their treatment.
Despite 84% feeling able to ask questions at diagnosis, 40% delayed seeking care, often because their primary care physicians dismissed their concerns, or due to lack of awareness or fear. Only 14% were diagnosed through clinical screening or routine care, while 85% were diagnosed after self-detection of symptoms.
“This highlights gaps in early detection for younger adults,” said Ms Merschdorf.
The burden of ABC extended to all areas of women’s lives. Eighty percent reported psychological distress; body image, fertility and sexual health concerns were widespread but rarely addressed; practical challenges, including childcare, housekeeping and transportation, were common, with many patients reporting unmet needs.
Access to precision diagnostics varied: 90% had genetic testing to see if they had any inherited mutations, yet only 59% had genomic testing of the tumour to see if there were any genetic mutations in the cancer itself, how active the cancer was and how likely it was to recur. Genomic testing of the tumour gives cancer doctors extra information on which to base treatment decisions, such as chemotherapy, radiotherapy and hormonal therapy.
While 77% understood the reasons for their treatment, 25% lacked clarity and only 46% of young women were offered more than one treatment option. Targeted therapies had the lowest levels of patient understanding. Online communities of women with ABC were a vital source of information and empowerment, but only 43% of patients were referred to these by their care team.
“Our analysis of young women living with ABC underscores a consistent theme,” said Ms Merschdorf. “The current standard of care, while medically advanced, remains deeply fragmented when it comes to the lived realities of younger ABC patients. From diagnosis delays to unmet psychosocial needs, patients face a system that too often demands self-advocacy in the face of fatigue, fear and financial strain.”
Young Survival Coalition plans further studies to explore the unique needs of patients with ABC.
Ms Merschdorf concluded: “Advanced breast cancer poses a complex set of challenges for younger adults, whose experiences with this incurable illness intersects with critical phases of career, parenting and identity development. Project 528 provides a roadmap for researchers to investigate the issues that respondents identified as the most pressing, while also guiding supportive services and advocacy organisations to align their programmes with those needs.
“Beyond research and services, these findings can inform the development of health policies that better reflect and support the lived experiences of young adults facing breast cancer. Ultimately, the goal is for these data to drive meaningful improvements in research, care, and policy that truly serve this community.”
Strengths of this survey include that the respondents were from many different countries and cultural backgrounds, but a limitation is that a significant number of responses came from the USA, which limits its global applicability. Other limitations include: the data were self-reported, which may introduce a potential for recall bias; and the accuracy of information regarding diagnosis details, treatment experiences and timeline of events may vary depending on the women’s memories and the time elapsed since their diagnosis.
Professor Fatima Cardoso, medical oncologist and President of the ABC Global Alliance, said: “This is an important study that shows, for the first time, the experiences of young patients living with advanced breast cancer and the challenges they face in their daily lives. It is concerning that not all of the women in this study were offered tests to see whether or not they had inherited cancer-causing genetic mutations, and to understand the biology of the tumour itself. In an age of precision medicine, all breast cancer patients should have access to these tests as they have a crucial role in treatment decision-making and hence impact on survival and quality of life. I hope that policymakers will take note of the results of this study and address the many gaps that it highlights in terms of diagnosis, treatment and supportive care, but also psychosocial and financial support.”
ABC is cancer that has spread from the site of the first tumour to other parts of the body. Currently, it is incurable, although treatments can slow the progression of the cancer, often for many years. The prevalence of people living with ABC is unknown (see note below) and has never been quantified in young women.
Christina Thammasen: her story
Christina, 45, lives in California with her spouse and three children. She was diagnosed with breast cancer at the age of 38. She has been living with metastatic breast cancer for over seven years and is doing well on her current treatment. She enjoys reading, exercising, spending time with her family and volunteering in her local community. She is also a Licensed Clinical Social Worker and co-facilitates the YSC Virtual Hangout. Christina is especially passionate about mental health awareness and support for cancer patients.
She said: “There is a distinct line in my life before being diagnosed with advanced breast cancer and my life after. I have worked hard to reclaim my identity as a breast cancer thriver, someone who isn’t just keeping their head above water but is trying to savour every moment of their life. I want to teach my children that even when life is unfair, because it is, you don’t give up, you have to keep fighting, you have to keep moving forward, you have to keep living your life.”
(ends)
[1] Abstract no: OR36, ‘Living with Advanced/Metastatic Breast Cancer under 40: global insights into diagnostic delays, treatment gaps, psychosocial burdens, and policy solutions from the project 528 patient experience survey’, by Jennifer Merschdorf and Mary Ajango, in ‘Best abstracts’ session, 15.10-15.55 hrs GMT, Auditorium 1, Thursday 6 November.
Christina Thammasen, diagnosed with advanced breast cancer at 38
Credit
Young Survival Coalition
Method of Research
Survey
Subject of Research
People
Article Title
Living with Advanced/Metastatic Breast Cancer under 40: global insights into diagnostic delays, treatment gaps, psychosocial burdens, and policy solutions from the project 528 patient experience survey
Article Publication Date
6-Nov-2025
Radiotherapy after mastectomy can be avoided, study finds
Radiotherapy can be safely omitted as a treatment for many breast cancer patients who have had a mastectomy and are taking anti-cancer drugs, a study shows.
An international trial found that patients with early-stage breast cancer who underwent a mastectomy – removal of the breast – had similar 10-year survival rates whether or not they received radiotherapy.
Experts say the findings should help guide treatment discussions, as many patients who currently qualify for radiotherapy after mastectomy under existing guidelines may not actually need it.
For many patients with early-stage breast cancer treated by mastectomy and anti-cancer drugs, chest wall radiotherapy has long been standard to kill any remaining cancer cells and lower the risk of recurrence.
The practice is based on trials from the 1980s, now considered outdated, leaving uncertainty about its benefit and leading to variation in use worldwide.
The SUPREMO trial (Selective Use of Postoperative Radiotherapy after Mastectomy), led by the University of Edinburgh, studied the impact of chest wall radiotherapy in patients at intermediate risk of breast cancer returning.
The group included women from 17 countries with one to three affected lymph nodes, as well as those with none but who had other tumour features of aggressive behaviour that increase the chance of recurrence.
All 1,607 patients in the study underwent mastectomy, axillary surgery – removing lymph nodes from the armpit – and modern anti-cancer therapy. They were randomly assigned to chest wall radiotherapy (808 women) or no radiotherapy (799).
There was no difference in overall survival of patients after ten years of follow up – 81.4 per cent of those who received radiotherapy were still alive, compared with 81.9 per cent of those who did not.
Radiotherapy also had no impact on disease-free survival – the length of time without any cancer returning – or on the cancer spreading from the breast around the body, the study found.
Radiotherapy had minimal impact on cancer recurring at the site of mastectomy. Nine patients who received the treatment saw their breast cancer return on the chest wall, compared with 20 who did not. Side effects from radiotherapy were mild with no excess deaths reported from cardiac causes.
Experts attribute radiotherapy providing less benefit than previously thought to progressive improvements in treatment, particularly better drug treatments, which continue to reduce the chances of the cancer returning, and boost survival rates.
The research team caution that the study only looked at those with intermediate-risk breast cancer. Patients with a higher risk of their cancer returning could possibly benefit from chest wall radiotherapy, they add.
The study is published in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2412225 [URL will become active after embargo lifts]. The international research team included scientists from the UK, Netherlands, Australia and China.
It was funded by a Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) partnership, EORTC, Dutch Cancer Society, Cancer Australia, Breast Cancer Institute, Edinburgh Cancer Centre and HSBC Trustees. The study was jointly sponsored by the University of Edinburgh, NHS Lothian and Public Health Scotland.
Professor Ian Kunkler, from the University of Edinburgh’s Institute of Genetics and Cancer, said: “The SUPREMO trial provides no evidence to support the continued use of radiotherapy to the area of the chest wall in most patients with intermediate-risk breast cancer who have undergone a mastectomy if they are also treated with modern anti-cancer drug treatment.”
Dr Nicola Russell, from the Netherlands Cancer Institute and study coordinator on behalf of the EORTC, said: “Although reported toxicity in the trial was mild, we know that almost all patients experience some side effects of radiotherapy, that can even develop even some years after treatment. Avoiding unnecessary irradiation will reduce both treatment burden and, for example, the detrimental effects on breast reconstruction for these mastectomy patients.”
Professor John Simpson, Director of the MRC-NIHR Efficacy and Mechanism Evaluation (EME) Programme, said: "It is fantastic that this long-term international clinical trial, led from the UK, has delivered high-quality evidence that was lacking in this important clinical area. The findings potentially allow patients to avoid unnecessary treatments, leading to more effective and efficient use of health and care resources.
"The trial emphasises how difficult, but really important clinical questions can be answered by broad collaboration in the research community and through public funding partnerships such as that between MRC and NIHR."
Journal
New England Journal of Medicine
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
