Breast cancer patients in LMICs need access to cancer medicines now

This past year I witnessed the diagnosis of a loved one with a terminal illness in Ghana, the spark of hope as he knew there were drugs in high-income countries that may be available and could prolong his life, the agonising wait while jumping through regulatory hoops and being buried in paperwork, and finally his last words, “I give up” before his ultimate death, unable to afford a medicine that cost more than his entire lifetime earnings.

A similar story is being played for the majority of the approximately seven million breast cancer deaths that occur in low- and middle- income countries (LMICs) every year – being dealt a curveball and having no hope of ever being able to afford the cancer medicines needed to cure them or prolong their life.

In low-resource settings, the notion that breast cancer is a death sentence is sadly pervasive, and it is founded in the lived experiences of patients: almost everyone they knew who had cancer died from their disease.

As we commemorate breast cancer awareness month globally, we celebrate a historic moment, having witnessed in the last few decades an extraordinary decline in breast cancer mortality ever [40% drop since the 1980s in high-income countries]. This is partly attributable to screening, which allows the early detection of the disease when it is easier to treat successfully, but also to the discovery of new and highly efficacious therapies for breast cancer.

While medicines have become more effective, however, their access has become more inequitable globally – and the survival gap between the world’s poorest and the world’s richest continues to widen.

In LMICs, breast cancer is the leading or second leading cancer diagnosed among women; and most people diagnosed with breast cancer will die from their disease. This has been attributed to multiple factors, including patient and diagnostic delays. However, the lack of access to cancer medicines for patients with a pathologically confirmed diagnosis is the cruellest global inequity.

Multiple studies have shown that even generic cancer medicines are not affordable out of pocket, let alone targeted breast cancer medicines for patients in LMICs. My scholarly work has focused on access to medicines in the last eight years and even though the current landscape of initiatives to address this challenge has been evolving and is promising, it is occurring at a painstakingly slow pace. Several patients have died since and more patients will die this year from deaths that could have been prevented with access to cancer medicines.

In Botswana, where I conduct most of my research work related to access to medicines, essential medicines for cancer as well as multimodality treatment for breast cancer are paid for by the government. Although there are challenges  of drug stockouts, cancer medicines coverage through universal health coverage is one of the sustainable approaches to making cancer care accessible and affordable to patients diagnosed in LMICs.

Two landmark initiatives in the last few years that promise to synergise and galvanise global efforts to promote access to breast cancer and other cancer medicines are the World Health Organization’s Global Breast Cancer Initiative (WHO GBCI) and the Access to Oncology Medicines Coalition (ATOM). The goal of the WHO GBCI is to save 2.5 million lives due to breast cancer in the next 20 years by strengthening and scaling up of services for the early detection and effective management of breast cancer globally.

The ATOM Coalition is an innovative initiative led by UICC, which aims to reduce cancer morbidity and mortality by working together with over 40 public, private and civil society organisations, to address the barriers that often inhibit the availability, affordability and appropriate use of oncology medicines, including breast cancer medicines, in low- and lower-middle income countries.

In conclusion, as we celebrate breast cancer awareness month this year, we celebrate survivors globally and we also remember the many lives lost to breast cancer in the world’s poorest countries because access to cancer medicines was completely out of reach for them.

Access to medicines is a critical and moral obligation. I am encouraged by the surge of initiatives especially the WHO prioritization of breast cancer, which is key in ensuring that a generation of young women diagnosed with breast cancer in the coming years will live full lives because of access to lifesaving cancer medicines.