The Changing Landscape of Breast Cancer Care

In October 1985, the first organized effort to draw widespread attention to breast cancer detection and prevention launched in the United States as a week-long event, initiated in part by the American Cancer Society. Since then, Breast Cancer Awareness Month has morphed into a global campaign to raise awareness of the disease, educate about early detection and prevention, and raise funds in support of worldwide research. Today, government agencies, medical societies, and nonprofit organizations work together to promote breast cancer awareness.

“For some, Breast Cancer Awareness Month is a moment to celebrate empowerment, but for others it can be a re-traumatizing experience," shared Dr. Deborah Serani, a trauma psychologist and professor at Adelphi University in New York, in a recent New York Times article, which explains that the month of October can, in fact, be a triggering tribute for many breast cancer survivors. The sentiment is echoed by Bri Majsiak, co-founder of The Breasties, who had a preventive mastectomy after the death of her mother from breast cancer: "Breast cancer is 365 days a year, not 31."

Due in no small part to global awareness efforts and transformative technological advances in breast cancer treatment, there has been a 40% decline in breast cancer deaths in the past 30 years. Nevertheless, current statistics remain sobering. An estimated 284,200 individuals (281,550 women and 2,650 men) in the U.S. will be diagnosed with invasive breast cancer in 2021, and approximately 44,130 people (43,600 women and 530 men) will die from the disease, making it the second leading cause of cancer death in women.

Six percent of all women will have metastatic breast cancer (MBC) at first diagnosis, with an estimated 5-year relative survival rate of 28%. The chances that a woman in the U.S. will die from breast cancer is about 1 in 39 (2.6%), with incidence rates increasing by 0.5% each year in this country. As of January 2021, there are more than 3.8 million women with a history of breast cancer in the U.S. But these national statistics tell only part of the story. While the incidence of breast cancer for Black women is close to that of White women, Black women have a 40% higher death rate from breast cancer. For women younger than age 50, the mortality rate among Black women is double that of White women.

Multidisciplinary Breast Cancer Care

Precision medicine has emerged as an important tool in fighting breast cancer. ACCC is committed to supporting pioneering, practical tools and education to help providers incorporate precision medicine into their programs and practices. In 2019, ACCC held a Multidisciplinary Metastatic Breast Cancer Summit focused on addressing disparities in care for patients with MBC. Leveraging telehealth solutions to improve access to supportive services was identified as a key action item in addressing this challenge. In 2021, ACCC held a series of focus groups to learn more about how cancer programs are successfully implementing telehealth to manage symptoms and treatment side effects, deliver psychosocial screening and support services, and provide genetic counseling and testing for patients with MBC.

Cancer programs have adjusted well to the recent expansion of telehealth to the delivery of supportive care services for patients with MBC. The transition to telehealth services has resulted in increased service use, decreased logistical and geographic barriers to supportive care, and overall decreasing disparities to access to supportive care. The next step is to refine and adapt these approaches to diverse patient needs to ensure telehealth delivery benefits as many patients as possible. Through a combination of education projects, ACCC is taking steps to provide opportunities to members of cancer care teams to facilitate optimal outcomes for each patient diagnosed with breast cancer.

Guest speaker and certified genetics counselor Katie Lemas, MS, CGC, recently spoke with CANCER BUZZ TV about genetic testing and telehealth, sharing what genetic counselors wish providers would say to their patients. In her discussion, Lemas addresses common barriers to genetic counseling and testing for patients with cancer and—from the genetic counselor’s perspective—how providers can help improve the uptake of testing delivered via telehealth. Genetic counselors, says Lemas, as members of the cancer care team, can help patients better understand their cancer diagnosis, make informed treatment decisions, and navigate the financial costs of testing.

Telehealth has forever changed the way cancer care team members interact with patients. In an upcoming ACCC webinar on Using Telemedicine to Assess Psychosocial Health, supportive care panelists will share practical tips on the use of psychosocial screening tools and how to effectively integrate them into practice, including the order, timing, and adaptation of various tools. Additionally, a live webinar hosted by two experts on the Virtual Assessment of Physical Function in Adults with Cancer will provide practical strategies to gather critical information quickly and effectively about patients' functional health—whether by phone or video. Proven methods to perform these assessments on adults with cancer—even when they are not in the physical office, will also be discussed. Free registration is available at the links provided.

Several novel therapies have recently become available for patients with breast cancer who have progressed following first-line and second-line anti-HER2 targeted therapies. ACCC’s CE initiative, Making Sense of the Evolving Standards of Care for Advanced HER2+ Breast Cancer Overview will feature a series of meaningful small-group educational sessions to help clinicians optimally manage HER2-positive breast cancer patients who have received prior treatment with anti-HER2 targeted therapies. Visit the website to join a group and receive CME credit.

Additional ACCC resources:

• Oncology Issues article: Carrie’s TOUCH: Supporting Black Women with Breast Cancer
• Metastatic Cancer Resource Library
• Multidisciplinary Team Communication in Metastatic Breast Cancer Survey Highlights
• ACCC Metastatic Breast Cancer Project Overview