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Risk of dying from early invasive breast cancer down by around two-thirds in the last 20 years

Tim Gunn
by Tim Gunn | In depth

13 June 2023

11 comments 11 comments


Today, more than 90% of women diagnosed with early-stage invasive breast cancer will survive the disease for 5 years or more.

That’s thanks, in part, to research. And the people who make it possible.

Between 1993 and 2015, more than half a million women in England were diagnosed with early invasive breast cancer. Not only did they face something life-changing, they also provided the evidence to change things for the better.

Here’s how. Patients can choose to share their NHS health data, which researchers can apply to use to track trends over time. 512,447 women contributed their information to a groundbreaking study we funded into how breast cancer mortality in England has changed since the early 1990s.

This is what the data showed us: women in England diagnosed with early invasive breast cancer today are around two-thirds less likely to die from the disease within the first 5 years than they were 20 years ago.

“The prognosis for patients with breast cancer has improved,” says oncologist and senior author Dr David Dodwell, from the University of Oxford’s Department of Population Health. “And that improvement is dramatic.”

Let’s put it another way. In the 1990s, 1 in 7 women diagnose with early invasive breast cancer would die from the disease within 5 years. Now it’s 1 in 20.

“Our general feeling that things are getting better has been confirmed,” continues Dodwell. “And not only that: we can probably be more optimistic than we had dared to hope.”

We can use that optimism now as much as ever. Things can still get better, which means there’s still more to do.

Connecting doctors and patients

This is the first study of its size to follow up patients for an extended period, and to map out how detailed characteristics of specific patients and their cancers relate to different outcomes. That means it does much more than tell us about the past. 

“Our study can be used to estimate risk for individual women in the clinic today,” explains Professor Carolyn Taylor, lead author of the study.  

“It gives doctors the data they need to make predictions, or prognoses, for women diagnosed with early breast cancer. These prognoses can help women understand their situation and plan their futures.” 

The power of prognosis

Doctors told Mairead Mackenzie she had breast cancer in 2002. Hilary Stobart received the same news in 2009. 

They’re just two of the women who contributed their data to the study. In the years since, they’ve become passionate patient advocates and leading members of the charity Independent Cancer Patients’ Voice. They didn’t just feature in this research: they helped shape it, making sure the researchers focused on the questions that matter most to people with breast cancer. 

At the time of their diagnoses, though, neither knew how to react. 

“Whenever you get a cancer diagnosis, it’s a terrifying moment in your life,” says Mairead. “Initially, everybody thinks they’re going to die next week, but studies like this one can give reassurance to patients about their life ahead. And now, women with breast cancer have a much better chance of surviving.” 

Mairead Mackenzie and Hilary Stobart
As patient representatives, Mairead Mackenzie (left) and Hilary Stobart helped point our researchers towards the most important questions for people with breast cancer.

Being diagnosed with breast cancer

Hilary didn’t have data like this to reassure her. She remembers the “dark night of the soul” she went through after her radiologist told her that it was very likely she had cancer.

“That was the appointment where my world fell in. 

“Ended up sobbing in the car park – my husband wasn’t there – ringing my husband.  

“I spent the next week or so waiting for the results to come back and worrying about whether I’d have to have chemotherapy or not. But, in actual fact, I was never going to have it.  

“I would have wanted to know the facts earlier. I just think we need more information.” 

That’s exactly what this study provides. It can help doctors guide women diagnosed with breast cancer through the darkness Hilary remembers so well. 

“When I was diagnosed 20 years ago, I was not given a prognosis other than the fact that this is serious and we need to treat you quickly,” adds Mairead. “But I think good, clear communication about prognosis can make a vast difference to a patient’s quality of life and how they can cope with things.” 

Understanding breast cancer

The study can help doctors do their jobs, too. “In the long term, perhaps the most important thing is that this is much better, more precise new information for clinicians,” says Dodwell. “They can use it to reflect on the discussions that they have with patients.” 

Hilary and Mairead agree. They both stress that doctors need to help patients understand that breast cancer is “not all one thing”. 

“People diagnosed with breast cancer may already know somebody who has died from it,” explains Hilary. “They could assume that they’re in the same position, but their risk of dying from it within 5 years might be less than 1%.” 

That’s because some breast cancers are easier to treat with new targeted drugs. The size of tumours, and whether they have spread into the lymph nodes, can make a big difference to someone’s prognosis, too. And screening helps find breast cancers at very early stages, making it more likely that treatment will be successful. 

For example, a patient in her 50s with a small, low-grade, hormone receptor positive breast cancer which hasn’t spread to the lymph nodes can be strongly reassured by the results of the study. They show that she has an excellent prognosis. 

In fact, the study shows that 95% of women diagnosed with early invasive breast cancer today will survive their disease for at least 5 years. Overall survival is slightly lower because some people in the study died of other causes within that time. 

A photograph of a breast cancer cell under a microscope

Our breast cancer research

A photograph of a breast cancer cell under a microscope
  • By uncovering the different types of breast cancer, we’ve worked out how best to treat it with other targeted drugs, like trastuzumab (Herceptin)
  • We’ve also worked on a host of other new treatments for early breast cancer, including novel hormonal therapies and chemotherapy drugs. 
A photograph of a breast cancer cell under a microscope

Learning over the long term

But the experience of having cancer can’t be reduced to a 5-year prognosis.  

With most people surviving early invasive breast cancer for longer than 5 years, it’s important to think beyond the length of typical clinical trials. 

“You don’t have much grasp of having cancer until you’ve had it,” explains Hilary. “You suddenly join a club that you don’t want to be part of, and you find you have an awful lot in common with the other people in the club. You have a different perspective on what’s important.” 

Hilary and Mairead brought that perspective to the study.  

“I didn’t think what would happen to me in the long term was at all important beforehand,” Hilary continues. “I just wanted to know whether I was going to get treated and be okay and here next year. But 10 to 15 years on, it does matter to me.” 

“The truth is, in clinical trials, it’s almost impossible to get data beyond 10 years,” explains Dodwell. “With this kind of work, it’s easier. What happened to patients diagnosed 20 years ago isn’t what will be happening now, but these messages are enormously informative. And they might be the only way for us to realistically understand the long-term outcomes after breast cancer.” 

The past and future of breast cancer research

That’s not the only area where we need to keep up the pressure on breast cancer. This study shows that 6 in 10 women diagnosed today have a risk of dying from breast cancer within 5 years of 3% or less, but there are still groups of women who face much higher risks. 

Taylor and Dodwell’s study can be used to identify these women and give them the best available treatments as quickly as possible. It can also help focus future research on their specific needs. 

We’re here to keep driving that research. And we don’t do it alone. We’re beating breast cancer because of the hard work and generosity of people like Hilary and Mairead. 

“I’m yet to meet a cancer patient who isn’t happy for their data to be used for this sort of purpose,” says Mairead. “If there’s a chance of doing something that might make it easier for those coming after, breast cancer patients, like all cancer patients, say yes.”   

“And,” adds Hilary, “if they hadn’t said yes, we wouldn’t be where we are now.” 

The people who make this possible

“We know our treatment now is good because of all the work that was done earlier,” Hilary continues. “That was the first thing that got me into patient advocacy.  

“I used to work as a hospital physicist, dealing with people with breast cancer. So I knew what it was like in the late 1970s. That was my first thought when I was diagnosed, but I quickly saw how things had changed.  

“I mean, I didn’t have to have chemotherapy. If it was 10 years earlier, I probably would have been given it.  

“Then I began to realise why. It was due to all the trials, and the thousands of women who were prepared to go into them.” 

Those women have left an incredible legacy. These results make that clear. 

Now we can see the improvements decades of research have made possible, and we understand how we can keep making them in the years to come. 

“It’s good news,” concludes Hilary. “It shows what we’ve done, and that we need to go on doing it. More studies like this one will be needed in the future. Breast cancer is still with us. There’s a lot more work ahead.” 

Tim

This article was updated after being reviewed by our stats team on 26/09/2023.

Taylor CMcGale PProbert JBroggio JCharman JDarby S C et al. Breast cancer mortality in 500 000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study; doi:10.1136/bmj-2022-074684

    Comments

  • Ms Maria Dale
    21 July 2023

    I’m a breast cancer survivor. I had a lumpectomy followed by mastectomy. Then I took Anastrozole for 5years. I’m 7 years post diagnosis.

  • Jim Coyle
    17 July 2023

    Thank you for sharing this info with me 2 years after my wife died of breast cancer 🤷‍♂️🤷‍♂️🤷‍♂️🤷‍♂️💔💔

  • Pam Walker
    17 July 2023

    High time something was done about Lung Cancer survival

  • Wendy London
    17 July 2023

    I lost my daughter to Triple Negative Breast Cancer and have been raising funds for research ( hopefully in that area) Has any more research been done and are we any nearer finding any new treatments ?
    Thanks
    Wendy

  • Sue Yeadon
    10 July 2023

    A really interesting article, Thank You. It helps me realise how lucky I’ve been. My diagnosis was completely unexpected and knock me for a six! I was diagnosed early through a Fast Track referral by my GP. My tumour was 10mm, it was oestrogen and progesteron positive and luckily it had not spread to my lymph nodes. I had a lumpectomy and lymph nodes surgery followed by 5 sessions of radiotherapy (so glad it wasnt 15 sessions as it would have been a few years ago – THANK YOU Reseachers !! I also decided I didnt want to take the Anastrzole (probably spelt that wrong) which was prescribed – I used the NHS “Predict” tool to look at risks versus benefits and it only gave me an improved outcome of +1% and I didnt think it was worth all the side effects and my consultant agreed with me when we looked at this together. I wonder if there are any medical trials going on now for women like me (and some of the others who have left feedback on here) where we too can contribute to help those who might follow us down this lonely road? Would be interested to know. THANK YOU ALL for all you do. x

  • Jean Mary
    9 July 2023

    So greatful to all involved in research,treatment and oncologist ‘s.My oncologist remarked to the nurse : This lady has lived long enough to have breast cancer twice.How blessed I am

  • Mary Pelton
    6 July 2023

    Has this research been used to model the NHSPredict tool I found so helpful when my oncologist discussed the pros and cons of chemo in 2019? With a stage1, HER pos tumour at the age of 68 the tool showed only minimal benefits from chemo which would probably be outweighed by serious side effects., so I did not have it.

  • reply
    Jacob Smith
    10 July 2023

    Hi Mary,

    Thanks for your comment.

    This research wasn’t used in the development of Predict, but you can find more information about how Predict was built here

    I hope that helps,
    Jacob, Cancer Research UK

  • Jean
    5 July 2023

    Excellent article on the great work being done, thank you.

  • Rachel Evans
    5 July 2023

    What a positive and informative article. As a fellow breast cancer suffer (now 3 years post treatment and well) it gives me enormous encouragement that the treatments offered today, give you a better outlook with most breast cancer patients remaining cancer free 10 years and onwards. There is much more work to do not only with treatment, but aftercare for patients who have gone through treatment and are suddenly left alone, often wondering what happened to them. I am amazed by the treatment I received during my journey and will be forever grateful to the NHS and the amazing research work undertaken and trials offered by Cancer Research and other crucial cancer agencies. Thank you all, so much and thank you to the wonderful people who share their stories and give others much hope.

  • Shilpa Arya
    4 July 2023

    Wr know there is inequaity inbrest cancer outcomes for ethnic minority women. Does this research show a reduction in the gap and/or improved outcomes for ethnic minority women? And if so, whaf ate the improvements, please.

  • Janice Coomer
    4 July 2023

    I found this article very interesting and informative. I was diagnosed with primary breast cancer in 2013. My tumour was HER positive so I had chemotherapy and herceptin treatments and I went on the Fast Foward trial for my radiotherapy – five sessions instead of fifteen. I have been taking Anastrozole for the past nine years but have been told that I will have to stop taking it next year and whilst I understand the thinking behind this decision, I am not happy with it.

Tell us what you think

Leave a Reply

Your email address will not be published. Required fields are marked *

Read our comment policy.

    Comments

  • Ms Maria Dale
    21 July 2023

    I’m a breast cancer survivor. I had a lumpectomy followed by mastectomy. Then I took Anastrozole for 5years. I’m 7 years post diagnosis.

  • Jim Coyle
    17 July 2023

    Thank you for sharing this info with me 2 years after my wife died of breast cancer 🤷‍♂️🤷‍♂️🤷‍♂️🤷‍♂️💔💔

  • Pam Walker
    17 July 2023

    High time something was done about Lung Cancer survival

  • Wendy London
    17 July 2023

    I lost my daughter to Triple Negative Breast Cancer and have been raising funds for research ( hopefully in that area) Has any more research been done and are we any nearer finding any new treatments ?
    Thanks
    Wendy

  • Sue Yeadon
    10 July 2023

    A really interesting article, Thank You. It helps me realise how lucky I’ve been. My diagnosis was completely unexpected and knock me for a six! I was diagnosed early through a Fast Track referral by my GP. My tumour was 10mm, it was oestrogen and progesteron positive and luckily it had not spread to my lymph nodes. I had a lumpectomy and lymph nodes surgery followed by 5 sessions of radiotherapy (so glad it wasnt 15 sessions as it would have been a few years ago – THANK YOU Reseachers !! I also decided I didnt want to take the Anastrzole (probably spelt that wrong) which was prescribed – I used the NHS “Predict” tool to look at risks versus benefits and it only gave me an improved outcome of +1% and I didnt think it was worth all the side effects and my consultant agreed with me when we looked at this together. I wonder if there are any medical trials going on now for women like me (and some of the others who have left feedback on here) where we too can contribute to help those who might follow us down this lonely road? Would be interested to know. THANK YOU ALL for all you do. x

  • Jean Mary
    9 July 2023

    So greatful to all involved in research,treatment and oncologist ‘s.My oncologist remarked to the nurse : This lady has lived long enough to have breast cancer twice.How blessed I am

  • Mary Pelton
    6 July 2023

    Has this research been used to model the NHSPredict tool I found so helpful when my oncologist discussed the pros and cons of chemo in 2019? With a stage1, HER pos tumour at the age of 68 the tool showed only minimal benefits from chemo which would probably be outweighed by serious side effects., so I did not have it.

  • reply
    Jacob Smith
    10 July 2023

    Hi Mary,

    Thanks for your comment.

    This research wasn’t used in the development of Predict, but you can find more information about how Predict was built here

    I hope that helps,
    Jacob, Cancer Research UK

  • Jean
    5 July 2023

    Excellent article on the great work being done, thank you.

  • Rachel Evans
    5 July 2023

    What a positive and informative article. As a fellow breast cancer suffer (now 3 years post treatment and well) it gives me enormous encouragement that the treatments offered today, give you a better outlook with most breast cancer patients remaining cancer free 10 years and onwards. There is much more work to do not only with treatment, but aftercare for patients who have gone through treatment and are suddenly left alone, often wondering what happened to them. I am amazed by the treatment I received during my journey and will be forever grateful to the NHS and the amazing research work undertaken and trials offered by Cancer Research and other crucial cancer agencies. Thank you all, so much and thank you to the wonderful people who share their stories and give others much hope.

  • Shilpa Arya
    4 July 2023

    Wr know there is inequaity inbrest cancer outcomes for ethnic minority women. Does this research show a reduction in the gap and/or improved outcomes for ethnic minority women? And if so, whaf ate the improvements, please.

  • Janice Coomer
    4 July 2023

    I found this article very interesting and informative. I was diagnosed with primary breast cancer in 2013. My tumour was HER positive so I had chemotherapy and herceptin treatments and I went on the Fast Foward trial for my radiotherapy – five sessions instead of fifteen. I have been taking Anastrozole for the past nine years but have been told that I will have to stop taking it next year and whilst I understand the thinking behind this decision, I am not happy with it.

Tell us what you think

Leave a Reply

Your email address will not be published. Required fields are marked *

Read our comment policy.