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the price of slow progress: how advancements in breast cancer care continue to fall short
7 minute read
even with positive changes being made, more work needs to be done to get screening and treatment for breast cancer where it should be.
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this article was produced by the healthing editorial team with the support of a grant from breast cancer canada. while breast cancer canada made the production of this series possible, they did not have any editorial influence or control over the content, including review prior to publication.
breast cancer is common in canada, with roughly one in eight women developing it at some point in their lifetime. while it’s not considered to be the same devastating result as it had been in prior years, with the death rate dropping by approximately 48 per cent since 1986, access to screening and treatments still isn’t where it should be.
the issue is that, even though improvements have been made, with early detection, more women with breast cancer can get adequate treatment to avoid a terminal diagnosis.
kimberly carson, ceo of breast cancer canada, notes that many provinces have lowered the age from 50 to 40 for screenings, but this change is not enough because the federal government guideline remains unchanged.
“the federal government is now in a position where they’ve dismissed the preventative health task force that was making that decision (to lower screening age),” she said.
she also notes that the committee has been dismantled to make way for a new one—one that would include experts who work with breast cancer patients, as well as people who have lived the experience, to ensure that the voices that know the most about the subject can be heard and taken seriously.
“if they’re looking at the screening age for women, it will include radiation oncologists, specialists in mammograms, so they actually have expertise providing them with input, and if it were something else that the preventative task force is looking at, they would be looking for individuals in that field,” she said.
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the new task force is making another step in the right direction by improving timelines as well.
“the last time that they looked at the mammograms, for example, was almost 10 years ago,” said carson. “they’re saying now, more timely review, so breast cancer canada advocated for nothing less than a two-year review.”
but even with positive changes being made toward policy, it has yet to trickle down to who it matters most: the patients.
a lack of breast cancer education
a survey conducted by breast cancer canada looked at various aspects of breast cancer screening and care to see exactly how it’s affecting canadians as it stands right now. in this survey, it was found that 97 per cent of those asked believed there was still significant room for improvement in care, while 91 per cent noted that equal access had yet to be achieved.
this is shown in how many women are actively getting the proper screenings, even when they reach the age set out by provinces, which is now 40 in ontario, british columbia, nova scotia, prince edward island, and the yukon. alberta and manitoba met the call for lower age availability to 45.
many of these screenings are also set up for self-referral, allowing women to bypass the wait to see their primary care provider first.
however, even with these screenings becoming available, movement on behalf of women in the country to take advantage of them is also lagging behind.
“we’re still not getting women out to do mammograms on a routine basis. our numbers in canada are quite low,” said carson. “we would prefer to see them at 80-90 per cent, but we’re seeing them closer to 60.”
there are a few reasons for that. many women are aware that these preventive measures are available, but access hasn’t quite caught up. for example, the wait time for many women to get a mammogram after scheduling an appointment can be eight weeks or longer, depending on where you live. during this time, carson notes that it’s either for people to forget or can’t find a way to fit something into their schedule when it’s that far away.
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fear is another driver, because many women don’t want to hear the words you have breast cancer, even if it’s diagnosed early enough to be effectively treated.
“we need to better educate people on why catching it early is so, so, so important. it is our first line of defence,” said carson, continuing. “if we catch it earlier, we can almost guarantee you a full recovery, and you’ll live cancer-free. we catch it later, those odds change dramatically.”
but it’s not just education among patients that’s lacking. primary care providers are also behind the pack in recognizing the importance of early detection and access to preventive measures.
“a lot of them still say, ‘oh, you have no family history, so it’s fine.’ it’s not fine. we know that it’s not just family history that gives you breast cancer,” said carson.
when looking at people who are younger than 40, those who make up four to five per cent of cases, it becomes increasingly more difficult to even get screening unless they fall into a high-risk category, even in situations where they suspect something might be wrong.
those living in remote communities also face barriers in both screening and treatment, highlighting that breast cancer doesn’t discriminate, but access to care does. fortunately, according to carson, new screening options are on the way that could help mitigate these issues.
“it’s coming where we’ll be able to do liquid biopsies, which is a blood test. there’s new technology that will read mammograms faster, and they’ll be predictive, so you may not have breast cancer today, but from your mammogram, we’ll be able to predict,” she said. “so, it’s really exciting technology, and if we’re able to predict, then we know you need a mammogram more often.”
these new technologies will be especially beneficial for people in underserved communities and remote areas.
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advancements in breast cancer treatment continue to fall behind
today, treatments continue to surpass therapies of the past, with more personalized medicine being the forefront of the approach. these therapies take into account specific subtypes of breast cancer as well as genetics, so that when a woman is diagnosed, she will get the therapy that’s right for her.
according to carson, since there are over 50 different types, this unique approach is required to give everyone an equal chance at survival.
“you wouldn’t expect every bra to fit every person, so why would you expect every treatment to be the same?” said carson. “we’re seeing new treatments all the time, and the one thing that we advocate for very strongly is that any new treatment that’s available should be available to our patients.”
however, that’s not always the case.
a drug called perjeta (pertuzumab), which can be a viable option for people living with metastatic her2-positive breast cancer as well as a sort of pre-treatment before surgery or other therapies in that same type, is a perfect example of how availability doesn’t always equate to access.
“we haven’t had availability to that drug for eight years, but other countries have,” said carson.
she notes that recently it’s changed, due to “a lot of advocacy work that we’ve been doing,” but “there are too many levels of bureaucracy” that continue to keep these well-working drugs out of the hands of canadian patients.
however, some provinces are working with fast-track programs in other countries that will cut through the red tape, ensuring better access to more effective treatments.
“ontario just made a huge announcement … around the fact that any of the oncology drugs that go through a process called orbis, which is like a fast-track process through the fda in the states, they will receive priority funding immediately,” she said. “they’ll be available immediately, so that takes your timeline from two years down to, could be anywhere from six months to a year, but significantly increasing the tracking to get that medication to patients.”
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working together to advance breast cancer care
as it stands, the powers that be are “not working together” in a way that’s conducive to timely change. that needs to change because the negative effects of these organizations working toward the same goal in different rooms fall on the backs of patients.
“our medical oncologists see it every day where they want access to these medications and they don’t have access to them, and if the patient,” said carson.
of course, people who can afford to pay out of pocket can do so to get these drugs, but that leaves a wide net of people who are not as financially secure to spend time they don’t have waiting for the right therapy.
“we’re looking at financial toxicity of a breast cancer diagnosis because patients are having to pay for medication,” carson said.
and if they can’t afford it?
“you receive an alternative medication that may not be the best one for your type of breast cancer. it may not be personalized enough.”
when that happens, these people are simply out of luck and more often than not experience worse outcomes, prognosis, and quality of life.
“what needs to happen is the medications have to be made available faster, approved faster, and the price negotiation has to happen faster. we applaud ontario for taking that step forward. that’s amazing, and we want the other provinces to follow suit on that,” said carson, continuing, “what we need to do as a society is all the stakeholders need to be at the table working together, and i think that’s the piece we’re missing.”
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