Risk of breast cancer death after a diagnosis of early invasive breast cancerBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1355 (Published 13 June 2023) Cite this as: BMJ 2023;381:p1355
- Mairead MacKenzie, patient advocate1,
- Hilary Stobart, patient advocate1,
- David Dodwell, senior clinical research fellow and clinical oncologist23,
- Carolyn Taylor, professor of oncology and honorary clinical oncologist23
Mairead MacKenzie and Hilary Stobart were diagnosed with breast cancer some years ago. They’re just two of the half a million women who contributed their data to our study of women diagnosed with early breast cancer in England. As patient advocates, they also helped to shape the study.
Hilary and Mairead both feel that up-to-date information is needed on outcomes after a diagnosis of early breast cancer. They used their expertise as patients to highlight how data from women diagnosed with breast cancer in the past could help in the clinic today. Moreover, the study also gave them a chance to reflect on all that has changed since they were diagnosed with cancer.
“You don't have much grasp of having cancer until you've had it,” explains Hilary. “You suddenly join a club that you don't want to be part of, and 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.”
Our study was informed by that perspective.
The study provides risk estimates for individual patients. Both Hilary and Mairead stress that doctors need to help patients understand that breast cancer is “not all one thing.” Prognosis varies widely according to risk factors such as tumour size, lymph node involvement and whether the tumour was detected by screening.
“When I was diagnosed 20 years ago, I was not given a prognosis other than the fact that this is serious and we need to treat you quickly,” says Mairead. “But I think good, clear communication about prognosis can make a vast difference to a patient's quality of life, and how they can cope with things.”
“When people are diagnosed with breast cancer they may already know somebody who has died from breast cancer,” adds Hilary. “They might assume that their risk is the same, but many of them might only have less than 1% risk of dying from breast cancer at five years.”
“For the majority of women, the prognosis is good,” agrees Mairead. “This study backs that up and gives reassurance—because, initially, everybody thinks they're going to die.”
The study shows that, for women diagnosed with early breast cancer, the risk of dying from it within five years reduced substantially between the 1990s and 2010-15. For most women diagnosed recently their five year risk of breast cancer death was 3% or less.1
Breast cancer patients have contributed to that improvement.
“I’ve yet to meet a cancer patient who isn’t happy for their data to be used for research,” says Mairead. “If there's a chance of doing something that might make it easier for those coming after, patients nearly always say yes.”
“And if people hadn't said yes, we wouldn't be where we are now, would we?” agrees Hilary “We know our treatment now is good because of all the work that was done earlier …the large numbers of trials and the thousands of women who were prepared to go into them.”
Our results are part of that legacy. They quantify decades of improvements and lay the foundation for more to come. Meanwhile, they can inform how doctors talk with patients about their prognosis today.
“It’s good news,” concludes Hilary. “It shows what we’ve done, and that we need to go on doing it. More studies like this one will be needed in the future. Breast cancer is still with us. There’s a lot more to do.”
Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from Cancer Research UK, the National Institute for Health Research Oxford Biomedical Research Centre, the UK Medical Research Council, and the University of Oxford for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: commissioned, not peer reviewed.