Turning progress in breast cancer care into better lives

When we meet Professor Fatima Cardoso and Dr João Mouta, Cardoso has recently returned from Hong Kong, where she spoke at the World Cancer Congress. Both are medical oncologists by background, specialising in breast cancer, and dedicated advocates for people living with the disease. They share a commitment to help people live fuller, longer lives after diagnosis, treatment and beyond. Prof. Cardoso is a newly nominated Board Member of the Union for International Cancer Control (UICC) and Founder and President of the ABC Global Alliance, alongside numerous other prestigious affiliations; Dr. Mouta is Principal Global Medical Science Leader for Breast and Gynecologic Cancers at Roche.

For Prof. Cardoso, that commitment has a personal beginning. Her interest in cancer biology drew her towards oncology, and her best friend’s breast cancer diagnosis helped shape her decision to specialise in the disease. Later, two surveys, BRIDGE1 and Silent Voices2, highlighted how isolated and overlooked many women living with metastatic breast cancer felt. It should be noted that breast cancer also affects men. As Cardoso recalls, attention was focused on stories of recovery, leaving those living with advanced breast cancer feeling that, without a “happy ending”, their stories were not being heard.

Prof. Cardoso wanted to change that. And it was that determination that led to the creation of the ABC Global Alliance. She began by helping develop evidence-based guidelines and bringing healthcare specialists together to improve care for people living with advanced disease, with patients involved from the start.  “It doesn’t make sense to me to do things for patients without them,” she says.

Dr. Mouta’s commitment to advocacy also began during his clinical training. In Portugal, he volunteered with the Portuguese League Against Cancer, helping train volunteers who supported people in hospitals over many years. Seeing the difference they made has stayed with him throughout his career and was one of the reasons he became involved with the ABC Global Alliance.

Over their careers, Prof. Cardoso and Dr. Mouta have seen innovation transform breast cancer outcomes and care. Advances in diagnostics and medicines, alongside improvements in surgery, radiotherapy and supportive care, have enabled earlier detection and more effective treatment. WHO reports that age-standardised breast cancer mortality in high-income countries fell by 40% between the 1980s and 2020.3 This progress reflects innovation across the care pathway, together with health systems’ ability to bring those advances to people who need them.

Mouta points to findings presented at the ABC8 conference in Lisbon in November 2025 as evidence of improving survival in metastatic breast cancer. The study, conducted in collaboration with Prof. Cardoso and the ABC Global Alliance, examined records from more than 60,000 people treated in the United States. Overall, the average survival for patients who began systemic treatment between 2011 and 2013, was 27.5 months. This increased over the following years and, for patients who began treatment between 2020 and 2022, average survival time increased to 34.3 months. Improvements varied by subtype, with almost no improvement in triple-negative breast cancer but with median survival surpassing 5 years for both hormonal-dependent and HER-2+ advanced breast cancer. These observational findings offer a picture of progress in everyday care and show that research and development of new treatments is making a real difference to the lives of people living with breast cancer.4,5

Progress in breast cancer care gives Prof. Cardoso and Dr. Mouta reason for hope. Yet breast cancer remains a significant and growing global health challenge, where further advancement is still much needed. For Mouta, three priorities stand out: continuing to improve survival, developing treatments that are tolerable and protect quality of life and ensuring advances in care reach the people who need them, regardless of where they live or their ability to pay.

People living with breast cancer deserve the chance to live fuller, longer lives after diagnosis, treatment and beyond. More time can mean moments with loved ones, doing things they enjoy or continuing to work if they choose. Mouta emphasises that how people feel during that time matters too: treatment needs to be effective and tolerable, supported by care that helps people manage their disease and carry on with everyday lives.

That support extends beyond medicines. Prof. Cardoso highlights psychological support, symptom management, palliative care and clear, compassionate communication with patients and families. Treatment and care needs can affect family routines, relationships and caring responsibilities. Relatives and friends may also need support as they help someone through periods of uncertainty while managing their own commitments.

People also need understanding and support at work and in their communities. Prof. Cardoso recalls a friend living with metastatic breast cancer who lost her job when she tried to return to work full time. Flexible working arrangements, time for treatment appointments and protection against discrimination can help people remain in employment if they wish. Listening to their experiences is essential to challenging stigma and shaping support around their needs.

The consequences of losing work or reducing working hours can reach beyond the individual, affecting household income, employers and the wider economy. Family and friends may also need to balance caring responsibilities with their own work and commitments at home. Supporting people to live well and remain active in the ways that matter to them can therefore benefit families and communities too.

For Prof. Cardoso, the gap between scientific progress and access is reflected in the ABC Global Alliance’s review of its ten goals, set in 2015 for the following decade, and recently updated ahead of the ABC8 Consensus Conference. Looking back in 2025, she says: “We had very important advances in all the goals, except one. And that was the goal of accessibility.”

“Things are worse now than they were 10 years ago in terms of inequities,” Prof. Cardoso adds. She emphasises that these differences exist both between lower- and higher-income countries and within individual countries. A person’s healthcare coverage, or whether they live in a city or a rural area, can affect the care they receive. A treatment being approved does not mean everyone who needs it can access it.

Financial pressures can make care harder to reach. Prof. Cardoso’s work with The Max Foundation illustrates this: in some communities, women cannot afford to travel for treatment, even when the medicine itself is provided free. The journey can cost almost their entire salary. Alongside differences in healthcare coverage, practical costs like these can place treatment beyond reach. Understanding these barriers is essential to making care affordable in everyday life.

Cardoso estimates that the treatments with the greatest potential to change the course of cancer reach only around 10–15% of cancer patients worldwide. She also cites a figure of around 70% of global cancer deaths occurring in low- and middle-income countries. These figures, which she discusses across cancer rather than breast cancer alone, underline the scale of the challenge she sees: rising cancer incidence in countries where healthcare services already struggle to meet people’s needs.

As populations grow and age, demand for care will increase further. IARC projects 3.2 million new breast cancer cases a year worldwide by 2050 if current rates continue.6 Prof. Cardoso warns that growing cancer incidence in low- and middle-income countries could lead to more deaths if access does not improve.

Both are candid about the work ahead. The progress they have witnessed gives them hope, but the need remains to improve survival, protect quality of life and ensure advances in care reach the people who need them. The benefits of innovation are not yet shared equally.

Prof. Cardoso does not expect inequalities in access to be resolved within five years. For her, meaningful progress requires a fundamental rethink of existing systems. “Our whole system is broken,” she says, calling for the courage to “throw this away and start fresh”. In the meantime, she takes a pragmatic approach, identifying practical changes: finding the lowest effective dose for targeted therapies to balance effectiveness and tolerability, simplifying clinical trials so more people can participate, and reducing bureaucracy to develop treatments faster and use resources more efficiently. Her priority throughout is to focus on what matters most to patients.

She also recognises the political climate in which decisions about healthcare are being made. She urges policymakers to protect investment in health and education. For Prof. Cardoso, these are essential foundations for a society’s ability to prosper, carry out research and innovate. “You cannot forget health and education,” she says. “You cannot let that deteriorate.”

Against this backdrop, both see investment in healthcare as more important than ever. Dr. Mouta calls for a shift in how the value of health and innovation is understood: looking beyond upfront costs and annual budgets to the longer-term benefits for people, societies and economies. “It really should be seen as an investment,” he says. For people living with breast cancer, better health can mean more time with family, greater independence and the opportunity to care for others, participate in their communities or continue working if they choose. These benefits extend beyond individuals and their families, creating value for health systems and wider society.

Delivering change will take patients, healthcare professionals, advocacy organisations, policymakers and industry working together, each contributing their experience and expertise.

In the company of Prof. Cardoso and Dr. Mouta, there is reason to believe that change is possible. Their commitment is deeply personal. They speak with conviction about what still needs to change and with a determination that leaves you hopeful about what can be achieved. At the heart of their work are the people whose lives could be better—and a shared ambition to bring better treatment, care and support to more people, wherever they live.