2020: NBCC’s Breast Cancer Deadline

The National Breast Cancer Coalition (NBCC) has worked for years to promote evidence-based medicine and to ensure that scientific information about breast cancer reaches women, informs policy, and impacts the direction of research. On September 20th NBCC raised the stakes. The coalition set a deadline to end breast cancer by 2020. Eradication is the goal.

The eradication of breast cancer is not a new idea. Numerous breast cancer organizations, research programs, treatment centers, and policy agendas have mission statements that specify cure(s), or the end of breast cancer, or the dream of a future without breast cancer, as their primary objectives. Hope for an eventual medical miracle has fueled the fund-raising of billions of dollars with this end in mind. Unfortunately, the goal has never been realized. And until now, there has never been a deadline.

In an NBCC white paper, the coalition explains why society needs to make a radical shift in its approach to breast cancer. Drawing together statistics and information from widely respected sources, the paper specifies that incidence rates continue to rise; advances in treatment are incremental at best; and, although our understanding of breast cancer has increased in the past forty years, little has changed for the diagnosed. In addition, what has changed can sometimes be more harmful than beneficial.

For instance, NBCC recognizes that there are more treatment options particularly in the realm of pharmaceuticals. The Food and Drug Administration (FDA) has approved over 60 drugs for breast cancer, and there are over 100 more drugs in the pipeline. The drugs given to patients are not necessarily based on unequivocal evidence of benefit or significant increases in survival. Of the more than 1500 breast cancer clinical trials currently recruiting patients, the majority are investigating the combining and dosages of existing drugs rather than the development of new treatment modalities.

This approach to drug manufacturing is not unique to breast cancer. Marcia Angell, of the Department of Social Medicine at Harvard Medical School, and former editor of the New England Journal of Medicine, reported in Big Bucks, Big Pharma that only 14 percent of the FDA’s newly approved drugs between 1998 and 2004 were actually new chemical compounds. However, oncology drugs represent the largest share of the global drug market, and sales are projected to grow at a compounded annual rate of 12 to 15 percent, reaching $75 to $80 billion by 2012. The growth of the oncology market relies on breast cancer treatment to ensure continued profits.

In addition to pharmaceuticals, NBCC points out that most of the diagnosed receive some kind of surgery whether or not their condition is life threatening. The treatment of stage zero breast conditions such as ductal carcinoma in situ (DCIS) clarifies this concern. DCIS does not produce symptoms and is not likely to progress to invasive breast cancer. The long-term survival rate is nearly 100 percent regardless of treatment. In 2002, however, 26 percent of patients diagnosed with DCIS were treated with mastectomy, and other treatments included lumpectomy, radiation, chemotherapy, and hormone therapy such as tamoxifen. Since the condition is not life threatening, the risks associated with surgery, radiation damage, side effects, anxiety, ongoing radiation from regular mammography, and increased medical costs call the benefits of treating this condition into question. [See also my previous post “1 in 8”– Fear Mongering and the Probability of Developing Breast Cancer.]

In terms of diagnosis, routine mammography screening has been the standard protocol and “early detection” the rallying call for the American Cancer Society’s National Breast Cancer Awareness Month. Mammograms frequently provide insufficient information to reach clear conclusions about the presence of tumors, and suspicious areas on a mammogram may or may not indicate cancer. According to the Institute of Medicine, 75 percent of all positive mammograms, upon biopsy, were “false-positives” (i.e., did not show the presence of cancer), and mammograms on average miss 25 to 40 percent of tumors that actually are cancerous. NBCC states that “evidence of actual mortality reduction is conflicting and continues to be questioned…If mammography has had any impact on mortality, it is certainly a very small one.” Relatedly, DCIS is almost always detected by mammograms, contributing to concerns about the role and efficacy of screening mammography.

Finally, NBCC argues that small reductions in mortality overall do not signify adequate progress in the war on breast cancer. Data from the National Cancer Institute do indicate that the last twenty years have seen a slight decline in breast cancer mortality overall. Whereas 117 women died of breast cancer every day in 1991, this number is 110 per day in 2010. The coalition points out though, that “If we continue making progress at the current rate, it will take more than 500 years to end breast cancer.” That’s a long time when some 40 thousand women and increasing numbers of men die from the disease each year.

All of this indicates that the dream of eradication is only a dream unless we take a radically new approach. What does the new approach look like? The details of the 2020 deadline are forthcoming. Generally speaking, NBCC says this:

“This effort will require a critical look at research and healthcare priorities, financial incentives, funding mechanisms and advocacy efforts. It will require a concentrated strategy to expand quality, evidence- based care. It must embrace unprecedented coordination, information sharing and accountability. It will require individuals and institutions to cooperate in new ways and to an extent never before considered.”

I look forward to seeing the details and learning about who is on board with this unprecedented effort. In the meantime, I admire NBCC’s audacity, commitment, and call for change. NBCC states emphatically:

“By calling for an end to breast cancer by 2020, NBCC is calling for the end of business as usual. We have no desire to increase awareness of breast cancer, or to continually increase funding for research. Indeed, our foremost goal is to bring about the demise of the organization by accomplishing its mission.”

Loud and clear, NBCC. Now, let’s join the hundreds of thousands of advocates, survivors, medical doctors, scientists, policy makers, journalists, and concerned citizens who see the forest for the trees. The clock is ticking!

For more information about NBCC and the 2020 Deadline read the executive summary and go to stopbreastcancer.org.

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