Striving towards better breast cancer outcomes: Improving survivorship through screening, treatment and access
19.10.22
This month as we observe Breast Cancer Awareness Month, we reflect on the progress we’ve made treating the disease and consider actions we can take to further improve outcomes for those living with breast cancer. We stand with the women and men who have faced a life-changing diagnosis and remember those we have lost due to this terrible disease.
As representatives of companies working to develop new treatment options for those living with breast cancer, we understand improving and extending lives following a diagnosis hinge on our ability to deliver solutions which are multi-faceted and build on the cooperation of a diverse group of stakeholders. We share a common goal: reduce the burden of breast cancer and improve the lives of those living with breast cancer.
While outcomes for those with a diagnosis have continued to steadily improve in recent years, breast cancer remains the most diagnosed cancer in the EU, impacting us all both directly and indirectly. Accounting for a tenth of all cancer cases and a third of those diagnosed in women, breast cancer is the primary killer of women under the age of 65.1 2
To continue improving life during and after breast cancer, we would like to highlight three actions we believe will help to save even more lives.
- Improve equal access to breast cancer screening across Europe
The sooner we detect breast cancer, the more likely we are to be able to successfully treat the disease. For those diagnosed at an early or localised stage, the likelihood of surviving five years following a diagnosis is 96% in the EU. For those diagnosed at an advanced stage, the potential for survival drops to an alarming 38%.[1] In addition to greatly increasing the likelihood of longer survival, breast cancer which is caught in the early stages is not only easier to treat, but also less costly.[2] [3]
The key to catching breast cancer early: screening. In fact, if all countries reached maximum screening coverage, 20%-29% of deaths linked to breast cancer could be prevented, with the biggest reduction occurring in Eastern Europe.[4]
Thankfully, the prioritization of screening is beginning to permeate our polices. Europe’s Beating Cancer Plan strives to support efforts to ensure screening is offered to 90% of the eligible population by 2025.[5] While this is a most essential goal, there needs to be an added element of equity to how we promote screening.
However, even if screening is available and free of charge, individuals may face barriers to access linked to cultural, educational, and socioeconomic factors. Studies show that individuals with a non-EU country of birth or low level of education, in addition to unemployed or retired individuals, are less likely to pursue cancer screening than their more educated and prosperous counterparts.[6] Our efforts to promote screening should therefore not just aim to increase availability, but also dedicate action to removing barriers which can deter uptake and limit access.
Ultimately, our ability to save lives hinges on our ability to detect breast cancer swiftly and accurately. Breast cancer screening in Europe has already had a significant impact on outcomes, preventing nearly 21,700 breast cancer deaths per year.[7] While we work to expand access, let’s also strive to remove barriers to save more lives.
- Harmonize national policies related to treatment
We are preventing, detecting, diagnosing, and treating cancer with greater precision thanks to personalization which enables us to tailor treatment according to the characteristics of the individual and the type of cancer. While Europe’s Beating Cancer Plan acknowledges and positions personalized medicines as part of the future of cancer care, capacities to harness its potential remain varied across Europe.
Additionally, this shift towards treatment tailored to the individual should include integrated care pathways considering factors such as age, gender and lifestyle, as a diagnosis will present different implications for each of these factors. An example of what integrated care could look like has recently been introduced by the Belgian Society of Medical Oncology. A “Supportive Task Force” has been established to assess integrated cancer care offered to individuals with cancer across the country. The model has evolved, with the creation of “support houses” affiliated with major cancer centers offering a wide range of integrative therapies for cancer patients at all stages of disease.[8]
As the future of care, our efforts to personalize medicine should not only consider the science behind our treatment, but how we build care pathways for patients.
- Speed up access to life-saving solutions
Where you live in Europe have an unfortunate impact on your likelihood of surviving a breast cancer diagnosis. The five-year survival rate for breast cancer is 89% in Sweden and Finland, but only 74% and 77% in the neighboring countries of Estonia and Lithuania.[9] While expanding access to breast cancer screening will improve odds of survival across Europe, this is only part of the picture as the availability of treatment and medicines also impacts outcomes.[10].[11]
Every day access to treatment is delayed puts the life of the person living with cancer at risk. While the European Commission in theory should grant a marketing authorization for a new medicine following EMA approval within 67 days, it can take up to 198 days.[12] In several countries, despite approval at the EMA level, innovative breast cancer medicines are subject to another layer of evaluation at the member state level related to reimbursement. In Romania, it takes an average of 899 days for treatments to be reimbursed while in Germany, the average is a mere 133 days. This means that someone in Romania may wait up to two additional years for a new, and potentially lifesaving, treatment.
Access to medicines which have been approved as effective and safe by the EMA should not be delayed or blocked by secondary assessments or lengthy reimbursement decisions. When every moment is a matter of survival, speeding up access to life-saving solutions should be a top priority.
The future of cancer care
We welcome cancer being recognized as a political priority and the Commission’s efforts to launch a cancer plan. We believe the ambition which has been demonstrated towards the field of research should be matched with a proper legislative environment which ensures we can continue our work to deliver new solutions to those living with cancer. We also believe that faster, more equitable access across Europe is an achievable goal shared by all stakeholders.
To back up our commitment with action, EFPIA’s members have committed to file for pricing and reimbursement in all EU countries as soon as possible and no later than two years from the central EU market authorization, provided local systems allow it. The commitment is designed to help deliver faster, more equitable access to medicines for patients across Europe. Companies’ progress against this commitment will be tracked in a portal that will systematically collect information on the timing and processing of P&R applications across the EU-27. The goal of this new tool is to increase transparency around market launches and to gain a deeper understanding of the kinds of solutions stakeholders will need to develop to overcome key access hurdles.
Looking ahead, EFPIA Oncology Platform members will continue to play a leading role in advocating for a successful implementation of the European Beating Cancer Plan’s measures and in developing therapies that give people the best chance of overcoming a cancer diagnosis.
Breast Cancer Awareness Month is an opportunity to re-affirm our commitment to researching and developing new treatments to address the unmet need in breast cancer. It is a reminder of the scale of the challenge we face in improving breast cancer outcomes, and of the potential progress we can make if we work together.
[1] OECD iLibrary Breast Cancer Outcomes retrieved 12 July 2022
[2] Sun L et al. Global treatment costs of breast cancer by stage: A systematic review. PLoS One. 2018 Nov 26;13(11):e0207993
[3] Johansson ALV et al. In modern times, how important are breast cancer stage, grade and receptor subtype for survival: a population-based cohort study. Breast Cancer Res. 2021 Feb 1;23(1):17
[4] Zielonke N et al; EU-TOPIA collaborators. The potential of breast cancer screening in Europe. Int J Cancer. 2021 Jan 15;148(2):406-418
[5] Europe’s Beating Cancer Plan. European Commission 3 February, 2021
[6] Bozhar, H et al. “Socio-economic inequality of utilization of cancer testing in Europe: A cross-sectional study.” Preventive medicine reports vol. 26 101733. 8 Feb. 2022, doi:10.1016/j.pmedr.2022.101733
[7] https://ec.europa.eu/research-and-innovation/en/projects/success-stories/all/improving-cancer-screening-across-europe
[9] Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer Statistics in the European Union: Incidence and Survival across European Countries. Breast Care (Basel). 2019 Dec;14(6):344-353
[10] Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer Statistics in the European Union: Incidence and Survival across European Countries. Breast Care (Basel). 2019 Dec;14(6):344-353
[11] Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer Statistics in the European Union: Incidence and Survival across European Countries. Breast Care (Basel). 2019 Dec;14(6):344-353