Lancet Breast Cancer Commission Report Addresses Challenges to Reduce Disease Burden

Reshma Jagsi, MD, DPhil

A major update to the breast cancer field in 2024 came in the form of the Lancet Breast Cancer Commission report which called attention to urgent breast cancer challenges as well as inequalities and paired findings with recommendations for a better way forward, according to Reshma Jagsi, MD, DPhil.^1,2

The Lancet Breast Cancer Commission report focused on the following 6 themes: prevent, personalize, include, collaborate, identify, and communicate. Notably, the identification of hidden costs and suffering related to breast cancer was addressed in the report and a call to action was issued for high-quality cancer registry data to be collected worldwide for those with metastatic cancers. The latter remains key as the number of people living with metastatic breast cancer is unknown due to a lack of data.¹

“It’s important to emphasize that this is not a one and done endeavor—this was something that brought together investigators from all over the globe who are continuing to collaborate and trying to build on this work to take the insights and the lessons that are in the report forward,” Jagsi said in an interview with OncLive^®. “I’m excited about opportunities to connect at the 2024 San Antonio Breast Cancer Symposium and [42nd Annual] Miami Breast Cancer Conference® and beyond with not only the collaborators on that report, but with the populations they represent.”

In the interview, Jagsi highlighted key takeaways from the Lancet Breast Cancer Commission Report and the necessary steps forward emphasized in the publication. Jagsi is the Lawrence W. Davis Professor and Chair in the Department of Radiation Oncology at Emory University School of Medicine and a radiation oncologist at Winship Cancer Institute in Atlanta, Georgia.

OncLive: What research are you most excited about from 2024?

Jagsi: Some of the most exciting developments of 2024 came from the Lancet Breast Cancer Commission [which] was a multi-year project that began during the disrupted time of the pandemic via Zoom, highlighting how technology has made it easier to embark on landmark forms of international collaboration. It was a unique collaboration of investigators and patient advocates all over the world to try to identify the unmet needs, gaps, and future directions for the breast cancer research field.

I’m particularly excited about the launch of that report that was published in The Lancet in April and that has [received] a fair bit of attention. At the 2024 San Antonio Breast Cancer Symposium there is a session devoted to discussing some of its key lessons and [it will also be highlighted] at the Miami Breast Cancer Conference [that I am cochairing in March 2025] where the chair of the report, Charlotte E. Coles,PhD, MRCP, FRCR, is going to be joining us as a speaker; we also have several other members of the commission who are deeply engaged.

What was the Lancet Breast Cancer Commission report?

The report focused on multiple areas and was organized into themes. The theme that I was most actively involved in was the theme [6] on patient empowerment and communication. We focused on trying to ensure that we support decisions with all the information that’s available and make sure that the wonderful research that’s being done in randomized trials gets to patients. [This is key] so that patients can reflect on the evidence and consider all the options that they have and make decisions that are concordant with their own values and preferences.

We reviewed best practices for communication and the need for culturally appropriate interventions. Right now, my colleague Sarah Hawley, PhD, from the University of Michigan and I are finishing the analysis of an Alliance randomized trial that evaluates a pretty sophisticated decision support intervention that our team developed, and there is definitely a need for more work along these lines. The insights from the Lancet Breast Cancer Commission were that there is so much space for us to do [more to] understand how to communicate with patients; that’s a priority.

Much of the Lancet Breast Cancer Commission report was focused on groups [of patients] who have been ignored or forgotten, and another key theme was how patients with metastatic disease have not gotten the attention that they should have. We don’t even have accurate information on the prevalence of metastatic disease because registries don’t collect rigorous information on this. We know that the landscape of management for metastatic disease has developed tremendously in recent years. Not only do we have inadequate information about patients with metastatic cancer, but there is a problem of patients with metastatic disease being left to feel abandoned, isolated, and alone. We use language in ways that sometimes is very unfortunate. We’ll talk about a patient having ‘failed,’ and of course the patient hasn’t failed—we have failed to control the disease in the patient.

This ends up relating back to the communication theme. There is so much that still needs to be done and [we must] communicate with patients that although a diagnosis of metastatic cancer is still typically viewed as incurable, some patients now live 10 years or longer with metastatic disease and some subgroups are beginning to be considered as having a chronic disease. There’s a whole spectrum of disease and it’s been treated as a monolith that has been largely ignored. That was another key finding of the report, and the report says, ‘With adequate resources and a shift in attitudes, it might be possible to cure some people, treat most, alleviate the suffering of all, and abandon no one.’ That was a beautiful part of the report.

What additional notable information came from the report?

The report highlighted [additional] groups that are systematically left behind, particularly focusing on the fact that the incidence of breast cancer is now projected to reach more than 3 million [people] per year by 2040 and that patients in low- and middle-income countries will be the hardest hit. Prevention is essential, and there was also a focus on the hidden costs and suffering that are burdens that come with breast cancer including the financial, physical, psychological, emotional, and social tolls of this disease.

This report was a tour de force, and it provides a roadmap of communication, inclusion, prevention, collaboration, and personalization; personalization is a real passion of mine as well. The work stream that was focused on personalization and optimization of care focused on all phases from diagnosis to treatment and onwards. As a radiation oncologist, a lot of my research is focused on whether we can deliver radiation treatment in ways that are more efficient, target only select patients to receive radiation, [and] identify patients who can omit it altogether. 2023 was a banner year for focusing on identifying populations of patients in whom it would be reasonable to consider omitting radiation. 2024 has been a year where we’ve had the tremendous accumulation of evidence to support shorter courses of radiation for many patients with breast cancer.

Can you tell me more about what we have learned in 2024 about shorter courses of radiation?

Data now for well over a decade have supported using 3-week courses rather than 5-week courses to the whole breast. But this past year, we saw the landmark publication of an updated [ASTRO] guideline on accelerated partial breast irradiation which makes treatment in as short as 5 days a reasonable option for many patients with breast cancer. We also saw [in] publications and at a number of conferences in 2024, both at European meetings as well as ASTRO, evidence supporting the use of that 3-week course of whole breast radiation even in patients who have node-positive disease where the regional nodal basins are being targeted [and] in patients who’ve had breast reconstruction. This is a wonderful way to reduce that burden on patients and optimize their care, and it illustrates how the field is continuing to build on the evidence assembled in the Lancet Commission report to the benefit of patients all over the world.

References

1. Coles CE, Earl H, Anderson BO, et al; Lancet Breast Cancer Commission. The Lancet Breast Cancer Commission. Lancet. 2024;403(10439):1895-1950. doi:10.1016/S0140-6736(24)00747-5
2. The Lancet Commission on Breast Cancer publishes recommendations for change. Cancer Research UK. April 16, 2024. Accessed December 5, 2024. bit.ly/3ZDaxpP