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Home » Breast Cancer, EU Health, Health

Prescription for change

Submitted by on 14 Jul 2017 – 09:10

Breast cancer is the most common cancer in women worldwide, and is the most common cause of cancer among women in most countries. If this situation is to change, urgent action is required at the policy level and broader collaboration is essential among policy makers, professional societies, healthcare professionals and patient organisations. Canvassing for change in the world of oncology policy making, the International Centre for Parliamentary Studies recently brought together key stakeholders to discuss strategies to improve prevention, treatment and care of breast cancer. Janani Krishnaswamy, Commissioning Editor, Government Gazette, highlights the major recommendations tabled at the roundtable

IMG_2054Breast cancer affects more than 360,000 women per year in the European Union and causes more than 90,000 deaths every year. The World Health Organisation estimates that breast cancer incidence will increase by at least 11% in the EU between 2012 and 2025.
Despite receiving high levels of media support, breast cancer continues to remain a major burden for European healthcare, with more than twice as many new breast cancer cases annually than new cases of other cancers in any other continent. (1) Whilst improvements in diagnosis and treatment have led to a reduction in mortality rates for breast cancer, efforts to prevent the disease have not been uniform across the continent. Treatment modalities across Europe do not seem to exhibit significant differences. However, national guidelines in each European country exist, exhibiting discrepancies in screening, diagnosis, surveillance and treatment of breast cancer.

The breast cancer landscape is changing.

For change to happen, we need policies that reduce the uncertainty around guidelines for screening, greater prevention, increased funding for clinical research and drug development. Urgent action is required at a policy level and broader collaboration is required among policy makers, professionals, patient organisations and other key stakeholders.

In order to find ways to reduce the European burden of breast cancer and improve care, surveillance and treatment of breast cancer, the International Centre for Parliamentary Studies brought together Members of the European Parliament, senior representatives from the European Commission, medical and clinical experts, patient groups and other key stakeholders in Brussels at the Breast Cancer Europe Roundtable 2016 on 28th November 2016.

In order to extract more value from healthcare budgets, Europe needs to find more ways to put its health systems onto a sustainable footing. Governments need detailed and actionable outcomes data to make informed decisions. With this in mind, the ICPS Roundtable provided a forum to effectively debate unsolved clinical and policy dilemmas and discuss the challenges that exist in preventing and treating breast cancer patients across Europe.

Chaired by John Bowis OBE, Former Member of European Parliament and Minister of Health (United Kingdom), over 40 breast cancer experts coming from more than 20 countries, examined a wide assortment of issues ranging from prevention and surveillance mechanisms to effective and active treatment, need for greater collaboration, reimbursement for treatment, data-sharing and the need for increased funding for patient-centred research.

The delegates also discussed facts about lifestyle and breast cancer and modifiable risk factors such as alcohol consumption and the increasing number of alcohol-related cancer deaths in Europe. (2)

Following a series of policy updates from representatives from the European Society of Breast Cancer Specialists (EUSOMA) and European Commission Initiative on Breast Cancer (ECIBC) and the European Parliament, clinicians, pathologists and researchers at the roundtable had a unique opportunity to appraise their work and provide solutions to some of the pressing challenges in treating breast cancer in Europe.

The delegates agreed that proven means of fighting cancer exist at every stage of the cancer continuum and tabled a few significant recommendations for policymakers.

1. Prevention: While there is no sure way to prevent breast cancer, there are things one can do that might lower the risk of developing cancer. Breast cancer prevention should be integrated into comprehensive breast cancer control programs and complement breast cancer awareness and early detection efforts. Participants of the roundtable agreed that prevention – i.e. identifying and addressing risk factors at an early stage is the best way to reduce mortality rates. Improving health-literacy and raising awareness about risk factors can reduce stigma, myths and misconceptions about breast cancer. Prevention and education is fundamental in reducing the burden of cancer, and across all pathologies will save money. It is also important for us to have a good understanding of how to reach the population. Perhaps, developing guidance on prevention could be helpful: It should be evidence-based and updated as new research informs clinical practice;

2. Equal access: Numerous barriers to timely and equitable access to quality breast health care exist across the cancer care continuum and often negatively impact cancer outcomes. Improving access to care and reducing disparities in outcomes requires identifying, understanding and addressing those barriers. Policymakers should aim to address these barriers and ensure equal access across Europe to standard care, expertise and clinical research;

3. Innovative treatments: There’s a need to introduce safe, effective and innovative treatments into standard care. Pathologists agreed that active surveillance is a good thing and having consent from patients at every stage of treatment is crucial;
4. Increase patient-centred research: There’s a need to encourage qualitative and quantitative patient-centred research so that collectively, we can build an evidence base. In order to identify and improve support and care gaps, we must all support increased collaboration in research and data-sharing;

5. Delegates noted that it would be wise to have recommendations on genetic testing which can be updated from time to time. The European Commission should provide indications on how to perform genetic research;

6. There’s a need for effective and increased collaboration at every stage of the cancer conundrum;

7. Optimising treatment: The issue of over-diagnosis and treatment of breast cancer received much attention among delegates as some commonly used treatments, from the use of a double mastectomy or even a combination of mastectomy and radiation might put patients at adverse risks. Policy intervention in treatment mechanisms can help reduce EU’s health burden;

8. Need for harmonised reimbursement policies: As reimbursement policies often influence choice of treatment, policy makers should address this to help spare patients from unnecessary treatment, and reduce their financial burden. Further, a patient-oriented review process, more transparency of requirements for test developers and a roadmap for approval process could empower patients;

9. More emphasis should be laid on education and role of GPs in treating breast cancer;

10. Multidisciplinary care should be evidence-based and co-ordinated at all stages of the care process from the point of diagnosis onwards, encouraging patients to take an active role;

11. Addressing male breast cancer: Male breast cancer is relatively rare, accounting for less than 1% of all breast cancer cases and 1% of all cancer cases in men. There is little awareness among men, and even among physicians, regarding the occurrence of breast cancer in males, given the ratio of female to male breast cancers is approximately 100:1. (3) Though symptoms, diagnosis and treatment are similar to female breast cancer, male patients are often diagnosed at a later stage when their cancers are more advanced, thereby leading to worse outcomes. Only greater literacy, increased research and active discussion among men’s health forums can transform the situation.

12. Increasing number of breast cancer cases may be due to changes in lifestyle habits, increase in sedentary lifestyle, weight gain and obesity. Further, meta analyses show that breast cancer risk increases by around 7-12% per unit of alcohol per day. Governments should urgently counter public ignorance about the link between drinking and cancer and introduce minimum pricing to prevent the number of alcohol-related deaths;

13. When discussing the economics of therapies it is important to distinguish between ‘cost’ and ‘cost-effectiveness’ – the latter taking into account patient outcomes. The cost-effectiveness of all cancer therapies is under particular scrutiny in light of the constraints on healthcare budgets;

14. When assessing and optimising the cost-effectiveness of cancer care, decision-makers should consider how service redesign might contribute to improved care and costs savings, and thereby support investment and further research.

References:
1. Stewart BW, Wild CP, editors (2014). World Cancer Report 2014. Lyon, France: International Agency for Research on Cancer
2. Alcohol-related cancers will cause about 135,000 deaths and cost the NHS £2bn over the next 20 years in England, unless concerted action is taken to highlight the dangers of drinking, health campaigners have warned.
3. Major differences between male and female breast cancers uncovered, but male patients still disadvantaged by lack of research, say investigators, European CanCer Organisation, March 2016

Delegates present at the Breast Cancer Europe Roundtable 2016 included:
Commercial Vice President EMEA, Agendia, Consultant, Ankara Oncology Training and Research Hospital, Coordinator – Gynacological Oncology, Antwerp University Hospital, Senior Oncologist, Antwerp University, Head of Department of Pathology, Antwerp University Hospital, Consultant Breast Surgeon, Athens Medical Center Clinical Director / Breast Surgeon, AZ Sint-Blasius, Head of Pathology, AZ Sint-Jan Brugge, Clinical Director, Brustzentrum Marienhospital Bottrop, Professor of Surgery, Breast and Endocrine Surgery Unit, Bulent Ecevit University – The School of Medicine, Head Breast Surgeon, Champalimaud Foundation, Manager, Oncology Corporate Affairs (Europe), Eli Lilly, EU Regional Advocacy and Professional Relations Oncology, Eli Lilly, Head of Unit, Health, DG Research and Innovation, European Commission, Group Leader, ECIBC, European Commission , Chief Executive Officer, European CanCer Organisation, Member – Austria, European Parliament, President, European Society of Breast Cancer Specialists, Dean, Faculty of Medicine, University of Prishtina, Professor of Plastic, Reconstructive and Aesthetic Surgery, Gent University Hospital, Breast Surgeon, ISALA Center, General Surgeon, Istanbul University, Professor, Dept of Breast and Endocrine Surgery / Senior Consultant, Kalolinska Institutet, Professor / Senior Physician, Kalolinska Institutet, Gynaecologist and Researcher ‘Cancer during Pregnancy’, Leuven University Hospital, Head, Oncology, Mather Teresa Hospital, Head, Breast Clinic, Mitera Hospital, Policy Lead – Oncology for Europe, Middle East, Africa, and Canada, MSD, Regional Director Medical Affairs, Oncology, Europe and Canada, MSD Associate Professor, National & Kapodistrian University of Athens, Chief SIS, National Cancer Institute, Full Professor, Netherlands Comprehensive Cancer Organisation, Clinical Director, Over Srl Italy, Radiation Oncologist, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Surgical Oncologist, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Breast Radiologist, The Netherlands Cancer Institute, Professor / Hospital practitioner, University Hospitals of Strasbourg, Technical Officer, WHO Regional Office for Europe, Health Economist & Health Policy Specialist, World Bank

The next edition of the Breast Cancer Roundtable will be taking place in June 2017. If you wish to attend, please contact information@parlicentre.org