It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
New ACS report: Breast cancer mortality continues three decade decline overall, but steeper increases in incidence for women <50 & Asian American, Pacific Islanders of all ages
American Cancer Society
image:
Breast Cancer Report from the American Cancer Society
The American Cancer Society (ACS) today released Breast Cancer Statistics, 2024, the organization’s biennial update on breast cancer occurrence and trends in the United States. The new report finds breast cancer mortality rates overall have dropped by 44% since 1989, averting approximately 517,900 breast cancer deaths. However, not all women have benefited from this progress, notably American Indian and Alaska Native (AIAN) women, whose rates have remained unchanged over the past three decades. Also concerning is the continued upward trend in breast cancer incidence, rising by 1% annually during 2012-2021, with the steepest increase in women younger than 50 years (1.4% per year) and Asian American/Pacific Islander (AAPI) women of any age (2.5%-2.7% per year). These important findings are published in CA: A Cancer Journal for Clinicians, alongside its consumer-friendly companion, Breast Cancer Facts & Figures 2024, available on cancer.org.
“The encouraging news is breast cancer mortality rates continue to decrease thanks to advances in early detection and treatment,” said Angela Giaquinto, associate scientist, cancer surveillance research at the American Cancer Society and lead author of the study. “But future progress may be thwarted by increasing incidence, especially among younger women, and consequences of the COVID-19 pandemic, such as delayed diagnosis due to interruptions in screening.”
Breast cancer is the most common cancer among U.S. women after skin cancer and the leading cause of cancer death in Hispanic women. In 2024, an estimated 310,720 new cases of invasive breast cancer will be diagnosed in women, and approximately 42,250 women are expected to die from the disease. While rare, this year, 2,790 men will also be diagnosed with breast cancer, and 530 men will die from the disease.
For the report, researchers analyzed population-based cancer incidence and mortality data collected by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR), and the National Center for Health Statistics. Combined SEER and NPCR data provided by the North American Association of Central Cancer Registries (NAACCR) were the source for short-term incidence trends (1998-2021) and contemporary incidence rates (2017–2021) by race and ethnicity, age, molecular subtype, state, and stage (SEER Summary).
“Women today are a lot less likely to die from breast cancer, but alarming disparities still remain, especially for Asian American, Pacific Islander, Native American and Black women,” said Dr. William Dahut, chief scientific officer at the American Cancer Society. “These gaps need to be rectified through systematic efforts to ensure access to high-quality screening and treatment for every woman.”
Other key findings from the report include:
AIAN women have 10% lower breast cancer incidence than White women, but 6% higher mortality, and only 51% of AIAN women 40 years or older had a mammogram in the past two years compared to 68% of White women.
Breast cancer in women under 50 years has increased in AAPI women by 50% since 2000, surpassing the rate in young Hispanic, AIAN, and Black women to become the highest rate alongside White women (both 86 per 100,000).
Black women continue to have a 38% higher breast cancer mortality rate than White women, despite a 5% lower incidence. Black women also have lower survival than White women for every breast cancer subtype and stage of diagnosis except localized disease, with which they are 10% less likely to be diagnosed (58% versus 68%).
To address ongoing cancer disparities in Black women, the ACS launched the VOICES of Black Women study in May 2024. The study aims to enroll over 100,000 Black women in the U.S. between the ages of 25 and 55 from diverse backgrounds and income levels who have not been diagnosed with cancer to better understand cancer risk and outcomes. For more information and to participate, visit voices.cancer.org.
“Building upon the progress we have made in reducing breast cancer mortality rates requires ensuring more individuals have access to breast cancer screenings,” said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. “Through cooperative agreements with all 50 states, tribal organizations and territories, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has been a lifeline for limited-income, uninsured and underinsured women, providing them with critical screenings and treatment. Congress has a chance to pass the Screening for Communities to Receive Early and Equitable Needed Services (SCREENS) for Cancer Act, which would reauthorize the NBCCEDP and expand its reach to more people who may not otherwise be screened. We urge Congress to take this step towards saving lives from cancer while reducing costs for our health care system.”
More information on breast cancer can be found here.
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About the American Cancer Society The American Cancer Society is the leading cancer-fighting organization with a vision to end cancer as we know it for everyone. For more than 110 years, we have been the only organization improving the lives of people with cancer and their families through advocacy, research, and patient support, to ensure that everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, X, and Instagram.
A new paper in the Journal of Breast Imaging, published by Oxford University Press, indicates that breast cancer mortality rates have stopped declining in women older than age 74, and reconfirms that breast cancer mortality rates have stopped falling in women younger than age 40. This finding for older women is new.
Breast cancer is the second leading cause of cancer deaths in American women, with over 42,000 women dying of the disease in 2024. Before 1990, female breast cancer rates had been rising, and breast cancer mortality rates had been flat or increasing. Since 1990 there has been a steady decline in breast cancer mortality rates, which public health observers attribute both to the widespread use of mammograms and improvements in treatment.
The researchers, Debra Monticciolo and R. Edward Hendrick, assessed cancer mortality rates collected and maintained by the National Center for Health Statistics since 1990. For U.S. women overall breast cancer mortality rates have decreased steadily from 1990 to 2022, falling by 43.5% over that period. The most recent trend has been a decrease of 1.23% per year from 2010 to 2022, the lowest rate of decrease recorded since 1990. For U.S. women ages 20 to 39 (combining all races/ethnicities), breast cancer mortality rates decreased by 2.79% per year from 1990 until 2010, but have remained flat since 2010.
The investigation found that for women 75 years and older, the breast cancer mortality rate decreased by 1.26% per year from 1993 to 2013, when the rate stopped declining. For Asian, Hispanic, and Native American women (of all ages), breast cancer mortality rates have stopped declining over the most recent period: since 2009 for Asian women, since 2008 for Hispanic women, and since 2005 for Native American women.
Previous research indicated that breast cancer mortality rates stopped declining for women under 40 in 2010. The researchers here found that in both younger and older groups, the end of mortality rate decline was primarily due to mortality rates no longer declining for White women under 40 and over 74, as well as unfavorable trends for Hispanic women ages 20-39 years and for Asian, Hispanic, and Native American women 75 and older. Breast cancer mortality rates in Black women continued to decline in all age groups.
The investigators conducting this study contend that mortality rates have stopped declining for women under 40 and over 74 due to significant increases in stage IV breast cancers at diagnosis in these two age groups. Stage IV (metastatic) breast cancer at diagnosis has an extremely poor prognosis: a 31% 5-year survival rate.
This study indicates that increasing rates of advanced stage breast cancer at diagnosis is an important reason breast cancer mortality rates are no longer declining at the rate they once did. The researchers believe that this may be due to healthcare protocols. While the medical community currently recommends a breast cancer assessment for all women by age 25, breast cancer screening is only recommended for women under age 40 who are at higher-than-average risk. Some guidelines discourage women over 74 from screening.
Breast cancer mortality rate ratios for Black vs White women show the widest gap for women under age 40 years, suggesting that younger Black women are especially in need of alternatives to our current breast cancer risk assessment, screening, and treatment strategies, according to the authors.
“The fact that breast cancer mortality rates have stopped declining for women over age 74 is an alarming new trend,” said Monticciolo. “This is in addition to women under age 40 no longer seeing mortality rates decline from breast cancer. These groups are exactly those discouraged from breast cancer screening by some U.S. guidelines.”
The paper, “Recent Trends in Breast Cancer Mortality Rates for U.S. Women by Age and Race/Ethnicity,” is available (at midnight on March 6th) at https://doi.org/10.1093/jbi/wbaf007.
To request a copy of the study, please contact: Daniel Luzer daniel.luzer@oup.com
ASHLEY PARISER, MD, SPEAKS WITH A PATIENT AT THE OHIO STATE UNIVERSITY COMPREHENSIVE CANCER CENTER—ARTHUR G. JAMES CANCER HOSPITAL AND RICHARD J. SOLOVE RESEARCH INSTITUTE ABOUT THE SUBTLE AND LESSER-KNOWN SYMPTOMS OF BREAST CANCER THAT WOMEN SHOULD BE AWARE OF.
Experts say this is very concerning, since most breast cancers do not present with a lump that can be detected by touch – and if they do, it often an indicates a fast-growing or advanced-stage cancer that is less treatable.
“Screening mammography is our No. 1 defense in detecting and addressing breast cancers at their earliest, most treatable stages, but it is also very important for people to be familiar with the look and feel of their own breast tissue so that sometimes subtle changes can be evaluated quickly to give us the best chance at early detection,” said Ashley Pariser, MD, a breast medical oncologist and director of breast cancer survivorship services at the OSUCCC – James.
“We want people to feel empowered about their bodies and know what is normal for them. Many breast changes are the result of aging and childbirth; however, breast cancer can present in a number of ways,” said Pariser. “It is important that people feel safe to address these concerns in a timely way with their doctor. We have made great strides in detecting breast cancers in far earlier, more treatable stages.”
breast puckering (an indentation that appears when you raise your arms)
loss of feeling in part of the breast
pitting/thickening of the skin on the breast
nipple discharge
In this new survey, just 31% of survey respondents recognized a retracted, inverted or downward-pointing nipple as a symptom of breast cancer, and just 39% recognized breast puckering as a symptom. Less than half of survey respondents were aware of loss of breast feeling (41%), pitting/thickening of the breast skin (45%) or nipple charge (51%) as concerns worthy of medical attention.
Confusion about breast cancer screening guidelines Pariser noted that screening mammography remains the No. 1 tool for early detection, yet new survey results show that a third of women say they are confused about recommendations for breast cancer screenings, particularly those under age 30 (44%).
“The best way for us to find breast cancer early is for women to present as soon as they notice a change, ideally even before they see a change. So that's why we recommend screening mammograms for those who qualify if we want to find breast cancer early,” said Pariser, who also is an assistant professor in the College of Medicine and an affiliate member of the Cancer Control Program at the OSUCCC – James.
The American College of Radiology and American College of Obstetrics and Gynecologists recommend begin screening at age 40 for people of average risk. OSUCCC – James breast cancer experts encourage each person to talk with their physician about their personal cancer risk and family history to personalize their screening plan.
Pariser notes that people with dense breast tissue should be closely monitored because they are at slightly higher risk and dense tissue can mask small tumors. Black and Ashkenazi Jewish people should also have a conversation about more intensive screening due to higher risk.
‘Won’t happen to me’ mentality According to the American Cancer Society, breast cancer remains the most common cancer diagnosed in women behind skin cancers, with just under 300,000 new cases and 43,000 deaths expected in 2023. This new consumer survey, however, shows that few believe they will get the disease, which afflicts about one in eight women. Among respondents, 75% of women and 91% of men don’t believe they will get breast cancer.
“So, although we are making great strides in terms of detection and treatment, unfortunately we live in a world where breast cancer is still a serious concern for people,” said Pariser. “Although the disease is less common in men, 1% of breast cancers occur in men. These cancers typically present as nipple changes, so it is also important that men feel empowered to seek medical attention for concerning symptoms, especially if they have a strong family history of breast cancer.”
Study results and methodology This study was conducted on behalf of The Ohio State University Wexner Medical Center/OSUCCC – James by SQL Server Reporting Services (SSRS) on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from Sept. 22-24 among a sample of 1,004 respondents. The survey was conducted via web (n=974) and telephone (n=30) and administered in English. The margin of error for total respondents is +/- 3.5 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.
Breast cancer screening is available at more than a dozen locations across Columbus and the surrounding communities. To learn more about breast cancer treatment and research at the OSUCCC – James, visit cancer.osu.edu/breastcancer or call 1-800-293-5066.
Most women know that a lump in the breast is cause for concern, but a new survey by The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute finds education is needed about the lesser-known symptoms of breast cancer to help flag concerns, identify breast cancer as early as possible and initiate treatment.
CREDIT
The Ohio State University Comprehensive Cancer Center
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
Tuesday, September 01, 2020
Venom from honeybees found to kill aggressive breast cancer cells
Dr Ciara Duffy at the Harry Perkins Institute of Medical Research. Credit: Harry Perkins Institute of Medical Research
Using the venom from 312 honeybees and bumblebees in Perth Western Australia, Ireland and England, Dr. Ciara Duffy from the Harry Perkins Institute of Medical Research and The University of Western Australia, tested the effect of the venom on the clinical subtypes of breast cancer, including triple-negative breast cancer, which has limited treatment options.
Results published in the prestigious international journal npj Precision Oncology revealed that honeybee venom rapidly destroyed triple-negative breast cancer and HER2-enriched breast cancer cells.
Dr. Duffy said the aim of the research was to investigate the anti-cancer properties of honeybee venom, and a component compound, melittin, on different types of breast cancer cells.
"No-one had previously compared the effects of honeybee venom or melittin across all of the different subtypes of breast cancer and normal cells.
"We tested honeybee venom on normal breast cells, and cells from the clinical subtypes of breast cancer: hormone receptor positive, HER2-enriched, and triple-negative breast cancer.
"We tested a very small, positively charged peptide in honeybee venom called melittin, which we could reproduce synthetically, and found that the synthetic product mirrored the majority of the anti-cancer effects of honeybee venom," Dr. Duffy said.
"We found both honeybee venom and melittin significantly, selectively and rapidly reduced the viability of triple-negative breast cancer and HER2-enriched breast cancer cells.
"The venom was extremely potent," Dr. Duffy said.
A specific concentration of honeybee venom can induce 100% cancer cell death, while having minimal effects on normal cells.
"We found that melittin can completely destroy cancer cell membranes within 60 minutes."
Melittin in honeybee venom also had another remarkable effect; within 20 minutes, melittin was able to substantially reduce the chemical messages of cancer cells that are essential to cancer cell growth and cell division.
"We looked at how honeybee venom and melittin affect the cancer signaling pathways, the chemical messages that are fundamental for cancer cell growth and reproduction, and we found that very quickly these signaling pathways were shut down.
"Melittin modulated the signaling in breast cancer cells by suppressing the activation of the receptor that is commonly overexpressed in triple-negative breast cancer, the epidermal growth factor receptor, and it suppressed the activation of HER2 which is over-expressed in HER2-enriched breast cancer," she said.
Western Australia's Chief Scientist Professor Peter Klinken said "This is an incredibly exciting observation that melittin, a major component of honeybee venom, can suppress the growth of deadly breast cancer cells, particularly triple-negative breast cancer.
"Significantly, this study demonstrates how melittin interferes with signaling pathways within breast cancer cells to reduce cell replication. It provides another wonderful example of where compounds in nature can be used to treat human diseases", he said.
Dr. Duffy also tested to see if melittin could be used with existing chemotherapy drugs as it forms pores, or holes, in breast cancer cell membranes, potentially enabling the entry of other treatments into the cancer cell to enhance cell death.
"We found that melittin can be used with small molecules or chemotherapies, such as docetaxel, to treat highly-aggressive types of breast cancer. The combination of melittin and docetaxel was extremely efficient in reducing tumor growth in mice."
Dr. Duffy's research was conducted as part of her Ph.D. undertaken at Perth's Harry Perkins Institute of Medical Research at the Cancer Epigenetics laboratory overseen by A/Prof. Pilar Blancafort. "I began with collecting Perth honeybee venom. Perth bees are some of the healthiest in the world.
"The bees were put to sleep with carbon dioxide and kept on ice before the venom barb was pulled out from the abdomen of the bee and the venom extracted by careful dissection," she said.
While there are 20,000 species of bees, Dr. Duffy wanted to compare the effects of Perth honeybee venom to other honeybee populations in Ireland and England, as well as to the venom of bumblebees.
"I found that the European honeybee in Australia, Ireland and England produced almost identical effects in breast cancer compared to normal cells. However, bumblebee venom was unable to induce cell death even at very high concentrations.
One of the first reports of the effects of bee venom was published in Nature in 1950, where the venom reduced the growth of tumors in plants. However, Dr. Duffy said it was only in the past two decades that interest grew substantially into the effects of honeybee venom on different cancers.
In the future, studies will be required to formally assess the optimum method of delivery of melittin, as well as toxicities and maximum tolerated doses
More information: Ciara Duffy et al, Honeybee venom and melittin suppress growth factor receptor activation in HER2-enriched and triple-negative breast cancer, npj Precision Oncology (2020). DOI: 10.1038/s41698-020-00129-0
UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER
While regular screenings may decrease the chance of diagnosis of advanced breast cancer in some women and lead to a 20% reduction in breast cancer mortality, other women will be diagnosed with advanced breast cancer despite screening at regular intervals. The chances of being diagnosed with advanced breast cancer are higher among women who are Black or Hispanic/Latinx as well as women who are overweight and obese.
In a study publishing December 7, 2023 in JAMA Oncology, UC San Francisco researchers found that regular screening is not always sufficient to prevent an advanced breast cancer diagnosis. To reduce the number of advanced cancer diagnoses, primary prevention is also necessary and should focus on assisting women who are overweight or obese attain normal weight, particularly women of color.
Advanced breast cancer is defined as American Joint Committee on Cancer prognostic pathologic stage II or higher. Advanced breast cancers are tumors that are large and/or have spread to lymph nodes or have other characteristics associated with poorer prognosis such as being high grade and estrogen receptor negative. They require surgery and systemic treatment and detecting breast cancers through screening before they become advanced may avert deaths from breast cancer.
Advanced breast cancer risk calculation for women who are screened regularly can guide screening frequency and supplemental imaging. Clinical risk factors associated with advanced breast cancer include high breast density, high body mass index, increasing age, family history in a first-degree relative with breast cancer, history of previous breast biopsies, and postmenopausal status. Black women have a two-fold higher rate for advanced breast cancer than White women among regular screeners.
To evaluate the population attributable risk proportions (PARPs) for advanced breast cancer – the proportion of advanced cancer incidence in the population attributed to a risk factor – the researchers conducted a cohort study using data collected prospectively from Breast Cancer Surveillance Consortium (BCSC) community-based imaging facilities from January 2005 to June 2018.
The participants followed were 904,615 women aged 40 to 74 (with a median age of 57) undergoing 3,331,740 annual or biennial screening mammograms. Among them, 1815 advanced breast cancers were diagnosed within two years of screening examinations. The risk factors that were examined included heterogeneously or extremely dense breasts, first degree family history of breast cancer, overweight/obesity (body mass index greater than 25), history of benign breast biopsy, and screening interval (biennial versus annual) stratified by menopausal status and race and ethnicity (Asian or Pacific Islander, Black, Hispanic/Latinx, White, other/multiracial).
Body mass index PARPs were larger for post-menopausal than for pre-menopausal women (30% vs 22%) and highest for post-menopausal Black women (38.6%) and Hispanic/Latinx women (31.8%) as well as for pre-menopausal Black women (30.3%). In addition, the overall prevalence of being overweight/obese was highest in pre-menopausal Black (84.4%) and postmenopausal Black (85.1%), and Hispanic/Latinx women (72.4%).
“Black and Hispanic/Latinx women are at higher risk of being diagnosed with advanced cancer than White, Asian, or Pacific Islander women, and this difference is only partially accounted for by screening,” said first author Karla Kerlikowske, MD, UCSF professor of Medicine and Epidemiology & Biostatistics and Co-PI of the BCSC. “Identifying risk factors that account for the largest proportion of advanced breast cancers among regular screeners and understanding the differences in factors associated with risk of advanced cancer by race and ethnicity is important for developing personalized, equitable screening strategies and primary preventions.”
Breast density PARPs were larger for pre-menopausal than for post-menopausal women (37% vs 24%, respectively) and premenopausal White women (39.8%) whose prevalence of dense breasts was high (62%). For both premenopausal and postmenopausal women, PARPs were small for family history of breast cancer (5% to 8%), history of breast biopsy (7% to 12%) and screening interval (2.1% to 2.3%).
Obesity is bigger risk factor than family history in the study
Among routinely screened women, the researchers found that screening frequency was a weak risk factor for advanced cancer and screening biennially vs annually accounted for only a small proportion of advanced cancer diagnoses in this study population. Being overweight or obese accounted for the largest proportion of advanced cancers in postmenopausal women (30%), while dense breasts accounted for the largest proportion of advanced cancers in pre-menopausal women (37%).
“This is the first study, to our knowledge, to calculate PARPs for advanced breast cancer,” said Kerlikowske. “We found that being overweight or obese accounts for the largest proportion of advanced breast cancers among postmenopausal Black and Hispanic/Latinx women. This contrasts with prior studies, reporting that overweight/obesity accounted for the largest proportions of invasive breast cancers for postmenopausal Black women, but not Hispanic /Latinx women.”
Family history of breast cancer accounted for a small proportion of advanced breast cancer in pre-menopausal (8%) and postmenopausal women (5%) in the study. Prior studies have shown that women perceive family history of breast cancer as the primary breast cancer risk factor, with others such as being overweight or obese or having dense breasts, as less important predictors. Kerlikowske adds that patients need to be educated on factors that contribute most to development of advanced breast cancer, and on primary prevention interventions that can modify these risk factors. Offering supplemental imaging with MRI or ultrasonography to women at high advanced cancer risk could also reduce the chance of being diagnosed with advanced cancer.
Additional authors include: Shuai Chen, PhD, Michael C. S. Bissell, PhD, Christoph I. Lee, MD, Jeffrey A. Tice, MD, Brian L. Sprague, PhD, and Diana L. Miglioretti, PhD
Funding: The research was funded by the National Cancer Institute (PO1CA154292 and RO1CA266377).
About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.
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
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
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."
