Breast cancer is now the world`s most common carcinogenic disease with the ailment likely to cause a million deaths a year by 2040, according to a new Lancet Commission on breast cancer. Around 7.8 million women were diagnosed with breast cancer in the last five years until 2020 and about 685,000 women died from the disease the same year, it said.

Further, in 2020, women around the world on average had a 1 in 12 risk of being diagnosed with breast cancer before turning 75 years old, and this incidence is rising, researchers found.

They estimated that cases of breast cancer cases will increase from 2.3 million in 2020 to more than 3 million by 2040, with low- and middle-income countries (LMICs) being “disproportionately affected”. By 2040, deaths due to the disease will be a million a year, the team added.

“This is neither acceptable nor inevitable as action now can prevent many of these future cancers,” the authors wrote. Knowledge gaps, such as unknown numbers of women with metastatic breast cancer in which the cancer spreads to other parts, continue to prevent effective action, they said.

The scale of suffering associated with breast cancer, along with other costs, are not well-measured, with the society and policymakers only seeing the “tip of an iceberg,” the authors of the commission said.

“Recent improvements in breast cancer survival represent a great success of modern medicine,” said the commission`s lead author, Charlotte Coles, University of Cambridge, UK, referring to 40 per cent reduced deaths due to the disease achieved in some high-income countries (HICs).
“However, we can`t ignore how many patients are being systematically left behind,” said Coles.

The commission builds on previous evidence, presents new data, and integrates patient voices to shed light on a large unseen burden, according to the authors.
It points to “glaring inequities” and suffering from symptoms, despair and financial burden due to breast cancer, which are often “hidden and inadequately addressed”.

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Laying out recommendations for tackling these challenges in breast cancer, the commission suggested better communication between patients and health professionals as a crucial intervention that could improve quality of life, body image, and adherence to therapy, and positively impact survival.
“Women`s fundamental human rights have historically been accorded lesser respect than men`s in all settings, with implications for patient agency and autonomy,” said Reshma Jagsi, Emory University School of Medicine, US.

“Every healthcare professional should receive some form of communication skills training. Improving the quality of communication between patients and health professionals, though seemingly simple, could have profound positive impacts that extend far beyond the specific setting of breast cancer management,” Jagsi said.

“Patients should be encouraged to exercise their voices, choosing their level of involvement in care decisions,” she added.
The commission also advocated for developing new tools and metrics that can capture the costs associated with breast cancer, including physical, psychological, social, along with financial costs.

“Global data are essential to expose and better understand and address the multiplicity of needs of all people affected by breast cancer and significantly reduce the global burden of preventable suffering,” said author Carlos Barrios, Oncology Research Center, Hospital São Lucas, Brazil.

In countries lacking affordable health care facilities, patients experience these costs more commonly and intensely, too often leading to catastrophic spending and impoverishment, said Barrios.

The 40 per cent reduction in deaths from breast cancer seen in HICs has not been achieved in most LMICs, where advanced stages at diagnosis and low diagnostic and treatment capacities contribute to poorer breast cancer survival rates, the authors said.

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While these survival rates exceed 90 per cent in HICs, the rates are 66 per cent in India and 40 per cent in South Africa, they said.
The authors also found that every country successful in improving breast cancer survival rates between 1990 and 2020 has the ability to diagnose at least 60 per cent of invasive breast cancers at stages and thus, argued for improved early detection programs.

The authors further called for “bold policy changes” that can reduce the population exposed to risk factors in their control such as alcohol consumption, being overweight and physical activity.

Up to one-quarter of breast cancer in HICs could be prevented by modifying risk factors for breast cancer, they said.
“We hope that, by highlighting these inequities and hidden costs and suffering in breast cancer, they can be better recognised and addressed by health care professionals and policymakers in partnership with patients and the public around the world,” said Coles.

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