Much of the research that focuses on finding solutions for breast cancer goes into stages of the disease preceding Stage IV. Stage III is described as “locally advanced breast cancer,” but metastatic breast cancer, or Stage IV, means the tumor cells have spread beyond the breast tissue and into other parts of the body.
It is estimated that a fifth of all breast cancer cases are either locally advanced or have spread to other parts of the body at diagnosis. In developing countries, the number can go up to 60%. Additionally, one third of early breast cancer cases will become metastatic regardless of care and treatment received. According to the American Cancer Society (ACS) the five-year survival rate after a stage 4 breast cancer diagnosis is 22 percent.
While the most pressing concern on most people’s minds is getting screened and diagnosed early, experts from all over the world are urging scientists, educators, and pharmaceutical/medical companies to devote more attention to Stage IV breast cancer.
Last Friday, the international guidelines for the management of advanced breast cancer was finally published in two of the most prominent oncology journals: The Breast and Annals of Oncology. Despite these updates, industry experts are still alarmed by the lack of research and development for the following Stage IV breast cancer-related health concerns:
- Breast cancer that has metastasized to the liver, pleural cavity, or skin.
- HER2 positive advanced breast cancer that relapses during or not long after adjuvant treatment with trastuzumab.
- Whether removal of the primary tumor increases odds of survival and quality of life.
- Men with advanced breast cancer who need to receive aromatase inhibitors.
Professor Fatima Cardoso, lead author and co-chair of these guidelines, and Director of the Breast Unit of the Champalimaud Cancer Centre in Lisbon, Portugal, believes one of the obstacles that research on Stage IV breast cancer faces lies with how clinical trials for treatments progress. Advanced breast cancer would initiate the first phases of investigation, but researchers would soon shift their efforts to early detection and treatment once they have obtained enough information on safety and efficacy.
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Cardoso does not have a problem with research initiatives dedicated to preventive and early interventions, but patients with an advanced form of the disease deserve as much updated medical attention and information as those diagnosed early. On average, it takes a decade to complete a long-term study conclusive enough to allow physicians to safely prescribe a particular treatment, but there aren’t enough of these for advanced breast cancer. Her and other experts’ plea is for researchers to continue to pursue testing treatments in metastatic settings, and not to immediately shift the focus to earlier stages.
The new international guidelines were developed by breast cancer experts from around the world during the 2nd International Consensus Guidelines Conference on Advanced Breast Cancer (ABC) in Lisbon, in November 2013. It amended the 2011 ABC1 guidelines, and brought to light new aspects of advanced breast cancer that need intensive research.