Breast cancer survival rates have reached unprecedented highs due to medical advancements, but a lack of healthcare access means more than half of public patients in Brazil are still diagnosed with advanced tumors, according to a leading oncological surgeon.
Dr. Wesley Andrade, a mastologist and the director of the Institute of OncoMastology and Advanced Mammary Surgery, said the disease has become more frequent globally, but is now highly curable when detected early.
Writing for the Pink October awareness campaign, an annual international health initiative held every October to highlight the disease, Andrade detailed how five decades of medical evolution have transformed breast cancer from a condition inevitably associated with mutilation and death into one that can be treated with precision.
Despite these scientific strides, Andrade warned that delayed diagnoses in Brazil's Unified Health System, the publicly funded healthcare service known as the SUS, are preventing women from accessing life-saving care.
He said recent data from the Panorama of Breast Cancer Care revealed that 51 percent of women diagnosed through the SUS present with the disease at an advanced stage.
The delayed diagnosis rates are particularly high among younger demographics. According to the data, 68.3 percent of patients aged between 20 and 29, and 61.9 percent of those aged between 30 and 39, arrive with advanced cancer.
Even within the priority screening demographic of 50 to 69 years old, 47.6 percent of patients receive a late diagnosis, Andrade said.
He noted that mammography coverage within the public system fell below 35 percent across all Brazilian states during the 2022 to 2023 period.
Andrade said the gap between the high cure rates achievable with early detection and the reality of late-stage diagnoses in the public system is a failure of access rather than science.
He said the next major medical breakthrough in Brazil may not come from a laboratory, but from ensuring that existing treatments reach all women in a timely manner.
Rising incidence
The Brazilian National Cancer Institute, the government agency responsible for cancer control and research, estimates there will be 78,610 new cases of breast cancer in the country in 2026.
Andrade said the number of new diagnoses remains elevated, with incidence rates increasing across several countries, including among younger women.
He attributed the rising frequency to a combination of longer life expectancies, as the disease is strongly linked to age, and the widespread use of improved diagnostic imaging.
Mammography, ultrasound, and magnetic resonance imaging are allowing doctors to identify smaller tumors at an earlier stage, he said.
Changes in reproductive patterns are also contributing to the increase. Andrade said women are experiencing later pregnancies, having fewer children, and breastfeeding for shorter periods.
He added that modifiable lifestyle factors, including obesity, sedentary habits, poor diet, and alcohol consumption, help explain part of the rising incidence, though none of these factors individually guarantee a person will develop the disease.
He said knowing the risks does not mean living in fear, but rather acting on the factors that can be modified and properly monitoring those that cannot.
While not all breast cancers can be prevented, Andrade said maintaining a healthy weight, exercising, eating a balanced diet, avoiding smoking, and moderating alcohol intake are key risk reduction strategies.
Treatment evolution
Andrade said breast cancer medicine has undergone a revolution in recent decades, shifting away from aggressive surgical interventions.
Until the 1970s, the prevailing medical consensus was that larger surgeries offered the greatest chance of a cure. Subsequent studies demonstrated that conservative treatments could provide excellent disease control for selected patients, Andrade said.
The introduction of sentinel lymph node biopsies, a procedure to test the first lymph nodes to which cancer cells are likely to spread, reduced the need for surgeons to remove all underarm nodes.
The development of oncoplastic surgery has also allowed doctors to treat the cancer while preserving or reconstructing the breast, significantly reducing the physical impact on the patient.
Andrade said medicinal treatments have evolved from early drugs like tamoxifen and trastuzumab to modern endocrine therapies, CDK4/6 inhibitors, anti-HER2 medications, immunotherapy, PARP inhibitors, and antibody-drug conjugates.
These advancements are part of a broader shift towards personalized medicine, driven by the understanding that breast cancer is not a single disease.
Personalized medicine
Subtypes such as Luminal A, Luminal B, HER2-enriched, and triple-negative exhibit different behaviors and require distinct treatment strategies, Andrade said.
He likened the medical approach to knowing a criminal well in order to choose the best weapons to fight them.
Doctors now tailor treatments based on the tumor's size, lymph node involvement, hormone receptors, HER2 status, and genomic characteristics.
Andrade said genomic testing can help identify which patients will benefit from chemotherapy, preventing individuals from undergoing unnecessary treatments.
He said modern oncology treats the specific biology of the disease in the individual patient, rather than simply targeting the location of the tumor.
These targeted approaches have significantly improved outcomes. In the United States, breast cancer mortality has dropped by approximately 44 percent since 1989, and the overall five-year survival rate now exceeds 90 percent, Andrade noted.
Warning for younger women
With incidence rates rising among younger demographics, Andrade warned that age should not be used as an excuse to ignore persistent symptoms.
He said young women should not simply accept that they are too young for the disease if they discover a lump that does not disappear, or if they experience skin alterations, nipple retraction, or a bloody discharge.
A portion of cases are linked to hereditary predispositions involving alterations in genes such as BRCA1, BRCA2, and TP53, which produce tumor suppressor proteins.
Andrade said patients with a family history of high-risk breast, ovarian, or prostate cancer should be evaluated individually.
Women identified as having a high hereditary risk may benefit from genetic counseling and intensified screening programs, he added.
Despite the challenges of rising incidence and delayed diagnoses, Andrade said the disease should be discussed with evidence-based hope.
He said breast cancer remains a serious and frequent condition, but it is increasingly one that can be diagnosed early, treated with precision, and cured.
