The burden of breast cancer is rising worldwide, however, in 2020 it was the most common cancer,

overtaking lung cancer for the first time in decades. With 70% of cases, indeed, in countries of limited

resources, compare this to 60% in 2008. So it’s a 10% increment in the proportion of women affected

in countries of limited resources with a disproportionate increase in mortality. 60% of the mortality

attributed to breast cancer worldwide is indeed in countries of limited income compared to a 50%

proportion a decade ago. So it’s a rising problem and more important is the proportion of women

diagnosed at age younger than 50. 50% of women diagnosed with breast cancer in countries of

limited resources are younger than age 50, they are premenopausal, compared to less than 20% in

countries of high income. So that adds to the burden of breast cancer in these countries – those are

young women in the prime time of their lifetime, they are tending children, families, they are working

mums, working ladies, with a lot of burden and quite important for society, not only for their families. In

addition that’s another economic burden not only attributed to the woman, herself affected, and,

excuse me, men are affected as well but they are only 1% as compared to the total population of

patients with breast cancer, but also the family, the productivity loss of the family, the caregivers, the

family members tending to the woman during her treatment journey.

 

We always talk about early detection but the first priority is to address the rising trend for the burden

of breast cancer. The most widely cited reason is, indeed, westernising women’s risk. That has been

talked about for the past couple of decades but hasn’t been really highlighted in awareness

campaigns. We know that westernising women’s risk is really associated with desirable changes of

improving socioeconomic status, more control of her life but also it comes with a more sedentary

lifestyle, bad dietary habits or poor dietary habits, less breast feeding, more smoking and,

unfortunately, more drinking lately. All these increase the risk for pre- and postmenopausal breast

cancer and, indeed, you’d be surprised if I tell you the proportion of women with obesity, the highest

increase has been documented in countries of Africa, Southeast Asia and the Middle East, the same

countries where you have the highest rise in the incidence of breast cancer. We need to talk about

this in awareness campaigns and highlight it as a modifiable risk factor.

 

In addition to early detection, and I’m not talking about national screening mammography, I’m talking

about awareness about the importance of early detection, excellent outcome when it’s early detected

and limited morbidity of interventions when it’s detected early because women are more scared about

the intervention rather than the disease itself. Also quite important to talk about practical diagnostics.

We do not need to have everything in place before we address diagnostic mammography or at least

the status of the oestrogen receptor for a woman recently diagnosed with breast cancer which cannot

be, indeed, identified in some countries as we speak right now. We don’t need to have a perfect

radiology service in place, perfect pathology service in place, we need to tackle those factors that

could improve outcome with rapid diagnostics that are simple and affordable.

 

We need to address also certain elements of multidisciplinary care. We need to highlight the

importance of resource-stratified interventions. We need to talk about access to therapeutics - access

to therapeutics in terms of facilitating drug approval processes; in terms of pricing. But, very

important, access to therapeutics could be even improved in countries of limited resources through

access programmes and clinical trials. We need to talk about more clinical trials in countries of limited

resources, simply because they create excellent infrastructure to improve healthcare; they train health

personnel; they improve patient outcome; they actually cut down the cost and facilitate access to

excellent recent therapeutics at a minimum cost. For the global community they help facilitate

completion of trials in a cost-effective manner, also facilitate a quick approval for new options. In

addition, they verify the results in different ethnic groups and also teach us about drug metabolism in

different ethnic groups. That’s why addressing clinical trials, particularly those that are associated with

optimisation regimens or de-escalating regimens, are quite important in countries of limited resources.

They are being done in high income countries, I wonder why not talk about it in countries of limited

resources.

 

There will be a debate entitled Can we afford the price of recently approved targeted therapeutics in…

actually not only in countries of limited resources, it’s actually globally and that’s quite important

because we do have many new drugs approved lately, over the past couple of years. They make a

huge difference, they impact overall survival. Women with metastatic breast cancer these days could

survive potentially a median of five years, so up to ten years even with new therapeutics. But they will

not be able to survive that long without access to the drugs. They are priced at a very high cost, out of

reach for many women around the globe. Even in high income countries if they are not insured they

cannot access those so what’s the point of innovation if it can’t improve survival? That will be the

subject of the debate. It will be between Richard Sullivan and Alex Eniu and I very much look forward

to moderating this debate and for the discussion that would follow.

 

What do you think could be done about this?

 

You’d be surprised how many groups are trying to facilitate access to drugs around the globe. We

have many organisations, they have to be commended for what they’re doing. The Max Foundation

managed to get Gleevec, a drug that’s considered a miracle for patients with chronic myeloid

leukaemia, for 35,000 patients around the globe free of charge. Can you imagine? Remember,

chronic myeloid leukaemia is a rare disease so when I say 35,000 patients, and probably even more,

that’s a huge proportion of those patients. That’s Max Foundation by itself. We have ATOM and I

don’t want to forget other initiatives but we do have a lot of initiatives. Indeed, at ASCO this year, we

managed to convince so many of those groups together under an initiative for improving access to

oncology medications around the globe. So let’s hope for the future.