This article is part of our special report Metastatic Breast Cancer: Still a lot to be done.
Although France is seen as a “leader” in organising the care of women with metastatic breast cancer, whose quality of life has become an essential aspect of patient care in France, screening – which can reduce mortality by 20% – needs to be stepped up. EURACTIV France reports.
“Within the EU, there are big disparities regarding breast cancer screening,” French EU lawmaker Véronique Trillet-Lenoir (Renew), who sits on the European Parliament’s special committee on combating cancer (BECA), told EURACTIV France.
Breast cancer is the most common cancer among women in Europe, with 400,000 cases per year and 100,000 deaths. In France, 10-15% of breast cancers are metastatic.
Trillet-Lenoir, who is also a hospital oncology practitioner in Lyon, said bilateral mammography can reduce breast cancer mortality by 20%, which explains why early detection is so important.
“The countries of the North are the most advanced, while the countries of the South and East are very late. There is a greater risk of discovering breast cancer at a late stage,” said Trillet-Lenoir, adding that “France is in the middle of the pack”.
Breast cancer can be broken down into three sub-categories. The most aggressive one is triple-negative breast cancer, with a median survival of less than two years, which accounts for 15-20% of the total metastatic breast cancers. The other two less aggressive forms have a life expectancy of five years.
To avoid metastatic breast cancer, it is thus necessary to “accelerate initial treatment and screening”, Trillet-Lenoir continued. Delays in diagnosis can lead to serious and aggressive forms of the disease, “even if progress has been made in recent years”.
This progress is reflected in breast cancer patients seeing an increase in life expectancy as a result of new treatments.
Improving patients’ quality of life
As the life expectancy of patients has increased, the authorisation of new drugs is now based on a dual assessment: therapeutic progress and the non-diminishing quality of life of women with breast cancer.
“France is the European country that has been working for the longest and in the most organised way on a national cancer plan. It can be considered a leader in the organisation of care,” said Trillet-Lenoir.
François-Clément Bidard, a professor of medical oncology at the Curie Institute in Paris, confirmed that “for the past four to five years, there has been a very strong tendency to systematically integrate the quality of life of patients when a new treatment is the subject of a clinical trial”..
But for women with metastatic breast cancer, the situation is slightly different. “The treatment’s effectiveness is still the primary objective, given that this is a fatal disease. This is the best guarantee of a satisfactory general state and quality of life,” Bidard told EURACTIV France.
A patient’s quality of life is measured through two levels of assessment, both at the research and consultation stage.
In terms of research, future drugs need to show quality of life criteria that are evaluated by questionnaires before they are to be put on the market.
When it comes to consultations, the second level of evaluation, Bidard said “we always try to minimise side effects. We propose solutions to deal with them”.
In practice, this translates into what is known as supportive care. The aim is to reduce all the symptoms experienced by patients whose quality of life is most affected by the disease. This care, which is not compulsory, is of “great benefit” to the patient’s treatment.
Finding a job, taking out a loan, or integrating into society is often a difficult process for women with breast cancer, which is why it is important to talk openly about the disease.
“Twenty years ago, few women dared to say they had metastatic breast cancer,” Bidard said, but “it is no longer seen as a shameful disease”.
In France, initiatives like Pink October have improved the lives of cancer patients. “Informing society of the fact that life expectancy is long and treatments are better and better tolerated favours job retention and non-discrimination,” Bidard also said.
Trillet-Lenoir, for her part, would also like to see the right to be forgotten, which applies to women cancer patients who no longer show symptoms after five years in France, to be “developped in all European countries”.
On patient care, she also called for “a Europe-wide training programme to move towards quality criteria that are the same for everyone. This would avoid a brain drain of carers like in Romania.”
The European Commission announced a European plan to beat cancer in February 2021, which aims, among other things, to improve access, quality, and diagnostics and also support EU countries in ensuring that 90% of the EU population who need breast, cervical and colorectal cancer screenings are offered screening by 2025.
[Edited by Zoran Radosavljevic]