Ms Sarah Downey
Association of Breast Surgery President, Consultant Oncoplastic Breast Surgeon, and Honorary Senior Lecturer
Each year, 55,000 UK women face breast cancer (CRUK Cancer Statistics). In the 1970s, survival was poor. Today, research and specialist care have transformed treatment and outcomes.
Five-year survival is now 85%, and surgery often maintains or enhances breast aesthetics. ‘Surgical de-escalation’ is the new buzzword. New wonder drugs destroy certain breast cancers before surgery in up to 70% of patients (Schmid et al., 2020). For most UK women, breast cancer is curable, whatever age they present.
Early breast cancer diagnosis
Mammographic breast screening improves cure rates by 20% and may reduce treatment aggression like mastectomy or chemotherapy (Marmot et al., 2013). Initially using basic X-ray, advances include digital and 3D imaging and MRI. In future, tests relying on protein biomarkers could be performed at home (Daily et al., 2022).
Oncoplastic surgery
In 2002, UK breast and plastic surgeons together developed new techniques to safely remove cancer (onco) while preserving the breast appearance (plastic) (Clough et al., 2010, Rainsbury, 2003). The UK is a world leader in oncoplastic surgery, setting global standards for surgical training and practice (Wyld et al., 2019).
Despite progress made in breast cancer treatment,
work must continue to ensure every woman
has the best possible chance of a cure.
Targeted therapies: silver bullets
New drugs that activate our own immunity against the cancer (immunotherapy) target specific cell receptors (eg. HER2) (Cameron et al., 2017) and target the machinery that repairs DNA (Tutt et al., 2021) or the cell growth cycle (Johnston et al., 2020) have transformed patient outcomes. For some aggressive breast cancers, combining immunotherapy and chemotherapy before surgery means there is no cancer left in nearly 70% of women afterwards (Schmid et al., 2020).
Multimodal therapy and surgical de-escalation
Surgery now plays a collaborative role in treatment, removing the main lump and using radiotherapy and drug therapy to treat cancer cells elsewhere. Surgery can be less aggressive, improving outcomes, with mastectomy and removal of all armpit glands no longer mandated for most patients (Curigliano et al., 2017, Morrow, 2017).
Global variation
Despite huge progress in treatment, many women worldwide still die needlessly from breast cancer (Elbasheer et al., 2025). Some countries cannot afford screening or complex therapies, and a lack of female empowerment and health education creates barriers to seeking and accessing care in time for a cure to be possible.
Despite progress made in breast cancer treatment, work must continue to ensure every woman has the best possible chance of a cure.
