Breaking down barriers to health equity in breast cancer

In my role, I have the opportunity to work side-by-side with the global breast cancer patient community every day. They share their achievements and challenges, as well as their experiences and needs to help guide the work we do at Roche – especially in support of our overall vision that no one should die of breast cancer. While the powerful stories of hope, love and resilience are an inspirational force, what always strikes me is the huge disparity in access to screening, diagnostics and treatment around the world. There are many factors that drive these disparities, like a person’s geographical location, their ability (or inability) to access a centre of excellence, their level of understanding of breast cancer, their race, age or the stage of disease, to name a few. The impact of disparities in access is clear to see, whereby in many low-and-middle-income countries, poor access to breast cancer care has resulted in high rates of incidence and mortality that are disproportionate to global averages.1

This inequity in breast cancer and women’s health is something my colleagues and I are steadfastly committed to changing every step of the way.

Awareness and education are critical to getting more people to take the first step in accessing breast cancer services, earlier. In many communities, low understanding of what to look for, stigma surrounding a cancer diagnosis, or pressure to be there for children and other loved ones may be the first barriers to a breast cancer diagnosis.

The factors driving these challenges are complex and multi-faceted, however, at Roche, we firmly believe – and have seen – that enabling and supporting grassroots programmes is one effective route to affecting long-term, meaningful and sustainable change. One example of this is theled by my colleague, Jacqueline Wambua, General Manager, East Africa, Roche, and her team. EMPOWER has brought together public, private and not-for-profit organisations to improve education around cancer, and expand access to breast, as well as cervical, cancer screening and treatment. Remarkably, the success of EMPOWER in penetrating deep into communities has also created a ripple effect for family-centric care, beyond only women’s cancers and women’s health.

Rapid detection and treatment of breast cancer, particularly at the early stages (when the chance of survival is highest) is critical for maximising the chances of a positive outcome.2 However, across and within countries, access to the same quality of healthcare services varies widely. On a population level, these can be broadly categorised according to country income status, culture and social justice (or injustice). For example, individuals in rural areas in high-income countries may still have to travel hundreds of miles to access screening services, while few clinics in high-density urban areas in low-income countries are facing huge demand for their services.

To help improve access in urban areas, we have recently partnered witha not-for-profit organisation working with cities around the world to improve access to quality, equitable care. In the next 30 years or so, the vast majority of urban population growth is expected to take place in low- and middle-income countries.3 Without the necessary infrastructure, systems and workforce in place, there is high risk that inequity gaps in urban areas will widen even further.

One project Roche has partnered with C/Can and other partner organisations on, is the Leadership Programme for Women in Oncology (LPWO). Women in healthcare are often seen as trusted and influential pillars of the community and there is a correlation between women in healthcare leadership roles and a greater focus on women’s health.4 However, representation in more senior healthcare roles is low compared to men.5 The LPWO – proudly run by women, for women – helps upskill and empower mid-career female oncologists in low-income countries through mentoring from female Senior Business leaders at Roche. The goal of LPWO is to enhance health system readiness for better access and care, and ultimately translate this into improved outcomes. Importantly, strengthening the presence and voices of women in this way has been shown to have a halo effect to empower future generations of girls and women.

Another geographical-based initiative we are proudly partnering on is thefor International Education in Gynecology and Obstetrics (Jhpiego) in support of the World Health Organization’sto save 2.5 million lives from breast cancer by 2040. As part of this effort, Roche aims to increase access to breast and cervical cancer diagnostics and treatment in sub-Saharan Africa, by collaboratively providing technical and clinical guidance to local healthcare providers, while working with local decision makers to support policy adoption and financing for education, screening and patient care programmes.

All those in the breast cancer ecosystem have a responsibility to tackle the inequities faced, and thoughtful collaboration is required across the entire breast cancer pathway. This includes patients, who too often find their voices are not heard.

At Roche, our goal is to do now what patients need next. The key to helping achieve this is our commitment that everything we do for patients, we do with patients – a commitment we take very seriously. One example of this is the Global Patient Think Tank (GPTT) we have convened. The GPTT consists of diverse multinational patient and community representative leaders, with the goal of calling for inclusion of the patient voice in global Universal Health Coverage (UHC) policy decision-making and national level UHC design, implementation and governance.

Clinical study design is another area where I share Roche’s focus on integrating patient feedback and insights. It is important that clinical studies are accessible, inclusive and representative of the diverse people living with breast cancer. Recently, we initiated our first breast cancer clinical study in Kenya, where we involved a nurse living with breast cancer to provide strategic input into the study design and ways that we can support people in deciding whether the study was right for them, as well as supporting those that decide to join and are eligible. By incorporating the experiences of someone living with breast cancer into the overall design and execution of the study, we were aiming to reduce the burden of participation, improve communication with participants and improve their overall satisfaction with the clinical study experience.

I am encouraged to see that the topic of health equity is getting the spotlight it so desperately needs, and I am proud to be part of an organisation that is prioritising equal and fair access to the same standards of care, regardless of an individual’s personal circumstances. But still, health equity needs to become a larger part of the conversation. We all have to acknowledge the inequities that exist around the world and work together to reduce the gaps because, at the end of the day, there is no one-size-fits all approach to achieving equitable access to breast cancer care.

References

1. Ginsburg O and Horton R. A Lancet Commission on women and cancer. Lancet. 2020;396(10243):11-13. doi:

2. Ginsburg O, et al. Breast cancer early detection: a phased approach to implementation. Cancer. 2020;15(126 suppl. 10):2379-93. doi: 10.1002/cncr.32887. PMID: 32348566; PMCID: PMC7237065.

3. Lincoln Institute of Land Policy. Patterns of Global Urban Expansion [Internet; cited October 2023]. Available from:

4. Batson A, et al. More Women Must Lead in Global Health: A Focus on Strategies to Empower Women Leaders and Advance Gender Equality. Ann Glob Health. 2021;87(1):67. doi:

5. McKinsey & Company. Women in the healthcare industry: An update [Internet; cited October 2023].