Women with early breast cancer today 66% less likely to die within five years than in the 1990s

Women in England diagnosed with early breast cancer today are 66 per cent less likely to die from the disease within the first five years than they were 20 years ago, a study has found.

The major study, funded by Cancer Research UK, included all 512,447 women diagnosed with early invasive breast cancer in England between January 1993 and December 2015, and followed them up until December 2020.

The researchers, from Oxford Population Health at Oxford University, found women diagnosed between 1993 and 1999 had a 14 per cent chance of dying from the disease during the first five years, while those diagnosed between 2010 and 2015 had a five per cent chance.

The study also mapped out characteristics of the patients and their cancer and enables doctors to provide accurate prognoses. It shows, for example, that a patient in her 50s with a small, low-grade hormone receptor positive breast cancer that has not spread to the lymph nodes can be strongly reassured, because she has an excellent prognosis.

CRUK’s chief executive Michelle Mitchell said: “It’s heart-warming news that women today have more time with their families and loved ones after an early breast cancer diagnosis. Receiving any cancer diagnosis is an extremely worrying time, but this study can give patients a more accurate prognosis and offer reassurance for many women.”

Hilary Stobart, 68, from Waterbeach, was a patient involved in this study.

She was told six days before Christmas in 2009 that she screening had identified that she had breast cancer. She had surgery, then was invited to take part in a research trial looking at optimising radiotherapy treatment.

The retired grandmother, who worked in IT for a Cambridge college, has since added patient views to various research studies.

Hilary said: “When you’re diagnosed with cancer, you suddenly join a club you don't want to be part of. But you find you have an awful lot in common with the other people in the club. You have a different perspective on what's important.

“I didn’t think the long-term was all that important when I was diagnosed. I just wanted to know if I was going to be treated and if I’d still be here next year. But now I’m 13 years on, I realise it’s so important for patients to know their prognosis and understand what happens after treatment.

“I really enjoyed being involved in this study because it shows what we’ve done and that we need to go on doing it. There’ll be more figures needed in another five years or another 10 years because breast cancer isn’t done. That’s really important.”

CRUK suggests the reasons behind the improvement in prognoses could include:

- success in identifying characteristics of breast cancer, which has allowed for more targeted treatments like trastuzumab (Herceptin).

- the introduction of new treatments for early breast cancer, such as novel hormonal therapies and chemotherapy drugs.

- improvement in radiotherapy thanks to clinical trials such as the CRUK-supported START trial , which is continuing, while studies like IMPORT-HIGH and PRIMETIME have yielded better understanding of how radiotherapy can be developed and used to make shorter, more effective treatment

- improvements in detection and breast screening, including improved public awareness of signs and symptoms.

Breast cancer remains the most common cancer in the UK, with about 56,800 new cases each year. Despite the progress, around 11,300 people still die from it each year, making it is the UK’s fourth biggest cause of cancer death.

CRUK estimates that by 2040, due to a growing and ageing population, there will be 70,300 breast cancer diagnoses each year.

Dr Carolyn Taylor, professor of oncology at Oxford Population Health and the lead author of the paper, said: “Our study is good news for the overwhelming majority of women diagnosed with early breast cancer today because their prognosis has improved so much. It can also be used to estimate risk for individual women in the clinic. Our study shows prognosis after a diagnosis of early breast cancer varies widely, but patients and clinicians can use these results to predict accurate prognosis moving forward.

“In future, further research may be able to reduce the breast cancer death rates for women diagnosed with early breast cancer even more.”

https://www.bmj.com/content/381/bmj-2022-074684