Recently, Barbara Jacoby wrote a blog post entitled, “What Are We Doing about Metastatic Breast Cancer?” In it, she made five assertions that need to be corrected with facts.
JACOBY’S ASSERTION #1
- Public support and and research funding for those with metastatic breast cancer is more than adequate
THE FACTS: According to an extensive analysis by the Metastatic Breast Cancer Alliance, metastatic breast cancer research makes up only 7% of the $15-billion invested in breast cancer research from 2000- to 2013 by the major governmental and nonprofit funders from North America and the United Kingdom. See www.mbcalliance.org/docs/MBCA_Full_Report_Landscape_Analysis.pdf
JACOBY’S ASSERTION #2
- Though a great amount of money and research is dedicated to early detection, people should do everything they can to get treated early because that will prevent a metastatic breast cancer diagnosis
THE FACTS: Breast cancer is an extremely complex disease. Some breast cancers will never become life threatening, even without treatment. And many others will metastasize, sometimes many years out, even when caught early. Some cancers are so aggressive that current treatments are ineffective, no matter how early the cancer is detected. Mammograms can’t tell us which breast cancers need treating nor can they overcome the shortcomings of our current treatments.
The majority of newly diagnosed metastatic breast cancer patients had early stage disease 5, 10, 15 or even 20 years earlier. They took advantage of mammograms. Many patients chose to have one or both breasts removed when they had early stage disease “to prevent the cancer from coming back.” The fact remains that research has not yet been able to explain for all patients which early stage breast cancer will return as metastatic disease. Research cannot yet explain the causes of metastasis and why cancer cells travel to particular organs. Metastatic breast cancer patients should not be made to feel guilty because “they did not do enough to be tested or checked.”
JACOBY’S ASSERTION #3
- All research in early breast cancer applies to Stage IV or metastatic breast cancer and all major research groups studying early stage disease are also studying metastatic breast cancer
THE FACTS: It is not scientifically correct to say that “all the major work” in breast cancer research applies to both early stage and to Stage IV breast cancer. Early stage disease and metastatic disease are very different in their complexity, molecular makeup and mutations. Also, breast cancer is not one disease and research about what drives one subtype of breast cancer does not apply to other subtypes. Clinical trial endpoints such as tumor shrinkage may not have relevance to tumor spread or metastasis.
JACOBY’S ASSERTION #4
- Survival rates of those living with metastatic breast cancer are improving because the author “has seen people who are living for 5-20 years with the disease”
THE FACTS: “Seeing” metastatic patients who survive 5 or 10 years does not accurately define the survival rates for the breast cancer community. The fact is that 40,000 women and men still die of breast cancer every year in the United States with metastasis the cause of virtually all deaths from breast cancer. Also, while some progress with research and new treatments has been made in reducing mortality rates from breast cancer, median survival after a metastatic breast cancer diagnosis is 3 years—and this has not increased meaningfully in more than 20 years!
JACOBY’S ASSERTION #5
- Everyone, including metastatic patients, should be optimistic about the future because research will permanently eradicate breast cancer
THE FACTS: Since only 7% of the $15-billion invested in breast cancer research from 2000- to 2013 by the major governmental and nonprofit funders from North America and the United Kingdom focused on metastatic breast cancer research (cited above), we cannot feel confident that research in the near future will permanently eradicate breast cancer or end deaths from the kind of breast cancer that kills—metastatic breast cancer.
The very low percentage of research spent on metastasis research also contradicts Jacoby’s assertion that major research groups “everywhere” are “vested in finding the answers needed to treat and eradicate Stage IV cancer.” The field of metastatic breast cancer research is relatively small. Most funding goes to support basic research. There is little research in metastatic breast cancer control or outcomes.
Finally, Jacoby informs us that we can easily confirm her assertion that there has been a lot of progress in metastatic breast cancer. All we need to do is to “check out the progress that is being made.” She evaluates progress based on the metastatic patients she has seen.
Knowing a few patients that have survived the odds does not make for accurate conclusions for the entire metastatic breast cancer community. The existence of “many” treatments and drugs does not mean they are appropriate for all subtypes. Sadly, researchers have not been able to identify the drivers of triple negative metastatic breast cancers, and for patients with this subtype, chemotherapies remain their “best” and usually “only” options. Such treatments with significant toxicities greatly impact patient quality of life.
Metastatic breast cancer is very different than early stage disease. There needs to be more research funding to combat this unique and deadly disease. In addition, in the United States, we lack accurate statistics on incidence, prevalence, and survival. And patients are challenged to find information and support services to help them live with this deadly disease.
Metastatic Breast Cancer Network