By Marc S. Hurlbert, Ph.D., Executive Director, Avon Foundation Breast Cancer Crusade
The field of breast cancer has witnessed remarkable progress due to dedicated biotechnology and academic scientists, advocates, patients, nurses and physicians. Sixty years ago, a woman diagnosed with early stage breast cancer had less than a 55 percent chance of living 10 years, while today those odds are greater than 85 percent. We have made great advances in detecting cancer early with imaging including digital mammography, ultrasound and, when appropriate, MRI. Less invasive surgery is the standard of care in most cases. Research has determined breast cancer is not a single disease, but rather 5 or so distinct types – and biotechnology has brought about targeted therapies like Herceptin® which have made survival possible for women with HER2+ breast cancer. Treatment today can be individualized based on what markers a tumor expresses using the Oncotype DX® and risk can be assessed in healthy women without cancer with the genetic BRACanalysis®. Progress in breast cancer has been possible because of the biotechnology industry, and these advances should serve as a shining example of what can be achieved with biotechnology.
These advances are remarkable. However, they do not currently benefit all women equally. There is a disparity in access to screening and treatment that leads to a disparity in survival. Mortality rates from breast cancer for white women and black women were essentially equal in 1975 and remained equal until the late 1980s. By 2005, the black:white rate ratio of breast cancer mortality was 1.36 for New York City, 1.38 for the US, and 1.98 for Chicago. The disparity in breast cancer mortality that has arisen in the last 15-20 years is primarily due to unequal access to quality early detection and timely and quality treatment.
The Avon Foundation Breast Cancer Crusade works to combat disparities in breast cancer and has awarded more than $740 million in grants to support access to care programs and research since 1992. As one example, in 2000 we launched the Avon Breast Health Outreach Program to support grass-roots community education throughout the country. Avon BHOP programs educate women in the hardest to reach areas, providing breast health education and support targeted to reach ethnic and minority communities, women from lower socioeconomic levels, the uninsured and women from the inner city to some of the most rural regions in the country. The Avon BHOP has educated more than 10-million women and linked more than 1-million women to mammography screening and early detection programs. Two-thirds of the women served were uninsured, 60% live below the federal poverty level, and 59% were from racial or ethnic minority groups. The Avon BHOP programs have successfully implemented evidence-based strategies to promote screening among the medically underserved. Highlights of a few Avon BHOP programs are in this video.
Linking women to screening and finding cancers when they are small and more treatable is only one approach the Foundation takes. In addition, we support a network of 100 Avon Safety Net Hospitals and ‘Avon Patient Navigators,’ which supports women from the screening process, through diagnostics, and helps them navigate the medical and financial maze of a cancer diagnosis to access quality treatment. The field of navigation and the evidence-base for this type of intervention is still developing. However, in early data analysis, several of the county and public hospitals that Avon Foundation supports report sharp decreases in late-stage diagnoses, increases in early stage-diagnoses and improvement in 5-year survival odds.
The Avon Breast Cancer Crusade is a global effort with programs in 58 countries. The Foundation works to improve the lives of women through grant-making already discussed and by disseminating best practices at our annual Breast Cancer Forum, convening experts and advocates, and linking groups that work on similar topics. This week we will extend our efforts at disseminating best practices globally through a partnership with the U.S. Department of State and our Breast Cancer Global Congress. More than 150 experts from 58 different countries will convene to share best practices and return home with knowledge that will help improve local breast cancer outcomes. The Congress will address topics including advances and future technologies in breast imaging, screening and early detection; global incidence, mortality and risk factors, including in low and middle income countries; advancing care in developing populations through participation in global clinical trials; as well as global cancer control and education programs. Speakers will also present an analysis of Avon Foundation-funded projects in different regions of the world
Much work remains to help women diagnosed with advanced stage metastatic breast cancer, women diagnosed with rare types of breast cancer like triple negative or inflammatory breast cancer and to develop new tools for diagnostics and prognostics. Delivering effective and affordable screening modalities and treatments to benefit all women, regardless of there socioeconomic status, should be the goal. 2012 marks the 20th anniversary of the Avon Foundation Breast Cancer Crusade and the 10th anniversary of the Avon Walk for Breast Cancer. Avon Foundation will continue our Crusade until we defeat breast cancer.