Knowledge in Motion: A decade reviewed, a future defined – The ABC Global Alliance 2015–2025 Decade Report and 2025–2035 Global Charter

Abstract

Breast cancer remains one of the most significant global health challenges, with approximately 2.3 million new cases diagnosed and 666,000 deaths every year. Advanced breast cancer (ABC) – encompassing locally advanced and metastatic disease – represents the leading cause of breast cancer-related mortality and morbidity worldwide. While early-stage breast cancer has seen remarkable improvements in survival rates in the past decade, outcomes for individuals with ABC remain sobering: only 32 % of women diagnosed with ABC survive five years post-diagnosis, and this figure drops to just 20 % for men.

The ABC Global Alliance was established in 2016 as a multi-stakeholder platform dedicated to advanced/metastatic breast cancer. Its vision: to improve and extend the lives of women and men living with ABC in all countries worldwide and to fight for a cure.

This special edition of The Breast is both a reflection on the past decade of progress across the ABC landscape, and a forward-looking roadmap for the future. It summarizes findings from the ABC Global Alliance's Global Decade Report 2.0 (2015–2025) and the newly defined ten goals set out in the 2025–2035 ABC Global Charter 2.0, signaling a renewed commitment to advancing ABC care globally over the next decade.

Highlights

• •The Global Decade Report 2.0 assesses ABC care progress from 2015 to 2025.
• •The new ABC Global Charter 2025–2035 sets 10 goals for the next decade.
• •Two surveys capture global patient and healthcare professional perspectives.
• •Multidisciplinary care, communication, and equity remain urgent priorities.

1. Introduction

Breast cancer remains one of the most significant global health challenges, with approximately 2.3 million new cases diagnosed and 666,000 deaths every year [1]. The 5-year prevalence (the number of people diagnosed in the last 5 years and still alive) is over 8 million [2]. Advanced breast cancer (ABC) – encompassing locally advanced and metastatic disease [3] – represents the leading cause of breast cancer-related mortality and morbidity worldwide [4]. While early-stage breast cancer has seen remarkable improvements in survival rates in the past decade, outcomes for individuals with ABC remain sobering: only 32 % of women diagnosed with ABC survive five years post-diagnosis [5], and this figure drops to just 20 % for men [5].

The Advanced Breast Cancer (ABC) Global Alliance was established in 2016 as a global multi-stakeholder platform or federation (since its members are organizations, not individuals) dedicated to advanced/metastatic breast cancer [6]. Originally established as an initiative of the European School of Oncology (ESO), it is now an independent non-profit organization headquartered in Portugal. The ABC Global Alliance unites over 300 member organizations across more than 120 countries. It has a clear vision: to improve and extend the lives of women and men living with ABC in all countries worldwide and to fight for a cure. By bringing together key stakeholders involved in ABC care, including patients, advocates, healthcare professionals (HCPs), policymakers, the pharmaceutical industry and diagnostic companies, the ABC Global Alliance co-creates and shares meaningful, practical solutions that reflect diverse perspectives. Through this shared purpose, the ABC Global Alliance is reshaping the future of ABC care worldwide.

This special edition of The Breast is both a reflection on the past decade of progress across the ABC landscape, and a forward-looking roadmap for the future. It summarizes findings from the ABC Global Alliance's Global Decade Report 2.0 (2015–2025) [7] and the goals set out in the 2025–2035 ABC Global Charter 2.0 [8], signaling a renewed commitment to advancing ABC care globally.

1.1. The Global Decade Report (2005–2015) and ABC Global Charter (2015–2025): A catalyst for change

The publication of the Global Status of ABC/MBC Decade Report 2005–2015 [9] marked a turning point in the global understanding of ABC. This comprehensive report highlighted critical gaps in patient care, societal support, and scientific research, as well as the need for coordinated action to address issues such as limited access to diagnostics and treatment, inadequate data collection, and the stigma faced by ABC patients [9].

Based on these insights, the 2015–2025 ABC Global Charter introduced ten ambitious goals aimed at transforming ABC care. These goals encompassed a wide range of priorities, from improving survival outcomes and quality of life to enhancing communication between HCPs and patients [10]. Over the past decade, the ABC Global Charter has served as a rallying cry for stakeholders worldwide, inspiring innovative programs, policy changes, and research initiatives.

1.2. Why update the Global Decade Report and ABC Global Charter?

As the decade 2015–2025 draws to a close, there is a need to assess the reality facing people with ABC in 2025. The conclusion? Progress over the last decade has been meaningful, but uneven. While some patients now live longer and better, many still lack access to basic diagnostics, treatment, coordinated care, and workplace protections. The world has also changed, with new treatments, technologies, and shifting societal attitudes transforming the healthcare landscape. Inequities have become impossible to ignore and have widened, both between and within countries. We have demonstrated that progress is possible, but a new decade demands a new vision.

2. The Global Decade Report 2.0: methodologies used to assess a decade of progress

The development of the Global Decade Report 2.0 2015–2025 and the 2025–2035 ABC Global Charter 2.0 was informed by extensive primary and secondary research conducted throughout 2023–2024, and expert consensus to capture the current landscape of care in ABC. While this manuscript outlines a brief overview of the methodologies used to measure progress against each goal, comprehensive details can be found in the appendices of the Global Decade Report 2.0 [7].

The ABC Global Alliance Steering and Advisory Committees selected 14 countries of interest for in-depth analysis throughout the research, which provided a balanced global representation of ABC care. Countries were chosen to reflect a diverse mix of high-, middle-, and low-income nations, encompassing various healthcare systems and sociodemographic contexts across all continents. The selected countries were the United States, Mexico, the United Kingdom, Portugal, France, Poland, Australia, India, China, Japan, Brazil, Colombia, South Africa, and Nigeria. While these countries represented much of the research focus, insights from other countries were actively encouraged and included.

2.1. ABC Global Alliance 2024 surveys

The report, and subsequently the manuscripts in this special edition, draw upon insights from two global surveys targeting HCPs and patients conducted between 04/03/2024–30/06/2024. The surveys aimed to better understand both the achievements and persistent challenges of the past decade from the perspectives of different stakeholders.

The HCP survey, with 461 responses from 78 countries, explored topics such as ABC care delivery, communication, the impact of ABC on quality of life, and beliefs surrounding ABC treatment, providing a comprehensive overview of current ABC practices. More than half (62 %) of respondents had over 11 years of experience in treating ABC, with 66 % working primarily in the public sector, 21 % in private practice, and 13 % in both.

The patient survey, which gathered 1254 responses from 59 countries, sheds light on the lived experiences of people with ABC, examining treatment, daily life, access to care, decision-making, information availability, emotional impact, and effects on work and daily activities. Most respondents (>99 %) were female, with 50 % diagnosed de novo, 44 % experiencing recurrent ABC, and 6 % unknown.

Surveys were disseminated online, so findings are influenced by local internet access. Because responses are self-reported, there is a risk of recall or social desirability bias; HCPs may answer in line with perceived professional norms, while patients may participate due to personal motivations, potentially skewing results. These limitations highlight the ongoing need for further research, particularly in underrepresented regions and specialties, and for qualitative follow-ups to deepen insights.

2.2. Clinical targeted literature review

A clinical targeted literature review aimed to evaluate the clinical efficacy of ABC treatments in randomized controlled trials (RCTs) over the past decade and assess their impact on survival outcomes.

A systematic search on EMBASE was conducted using specific terms related to ABC (including metastatic breast cancer, and locally advanced breast cancer), treatment types, RCTs, and survival outcomes. The search was limited to studies published between 2015 and 2024 with abstracts available. Inclusion criteria focused on ABC patients, licensed pharmacological treatments, and Phase III RCTs reporting efficacy outcomes like overall survival and progression-free survival. Exclusion criteria included non-pharmacological treatments, observational studies, and publications before 2015. A total of 50 studies were included in the review.

2.3. Interviews with global registries

A series of virtual discussions with the International Agency for Research on Cancer (IARC) from the World Health Organization (WHO) were held in 2024 to better understand the evaluation of population-based cancer registries across the globe. In addition, five virtual structured interviews were conducted in 2024 with registry representatives from New Zealand (Te Rēhita Mate Ūtaetae), France (Epidemiological Strategy and Medical Economics, ESME), the Netherlands (Netherlands Cancer Registry), the UK (National Audit of Metastatic Breast Cancer, NaOMe) and Germany (OPAL registry). These interviews aimed to gather insights from national cancer registries and understand best practices, challenges, and opportunities for improving ABC data collection. In 2025, an additional virtual interview was conducted with representatives from Cancer Focus Northern Ireland and the Northern Ireland Cancer Registry (NICR) to discuss progress in ABC data collection in the country.

Interview discussions were focused on current data collection methods, challenges in registering relapse data, barriers to data collection, and suggestions for future improvement.

2.4. Humanistic targeted literature review

A targeted literature review aimed to evaluate studies reporting the humanistic burden (e.g., health-related quality of life (HRQoL), caregiver burden) associated with ABC.

A systematic search of EMBASE was conducted to identify studies evaluating HRQoL, patient-reported outcomes (PROs), and caregiver burden in the context of ABC. The search was restricted to publications from 2015 to 2024 with available abstracts. Studies were included if they focused on ABC patients and were either RCTs or observational in design. Studies examining only a single pharmacological intervention were excluded, as they were not considered to provide a comprehensive or holistic view of quality of life (QoL). Publications prior to 2015 were also excluded. A total of 122 studies were included in the review.

2.5. Analysis of multidisciplinary team integration in ABC care

To evaluate how multidisciplinary team (MDT) approaches are recommended and implemented in ABC care across diverse healthcare systems, 200 documents (e.g., guidelines or policies) from 12 countries (Australia, Brazil, China, Colombia, France, India, Japan, Mexico, Nigeria, Poland, Portugal, South Africa, the UK, and the US), focusing on local, national, and regional levels were analyzed. Analysis focused on the composition of MDTs, regional differences in MDT recommendations, and any evidence of implementation of MDT practices. Sources included international consensus guidelines, national cancer plans, and peer-reviewed publications.

2.6. Global analysis of communication skills training

To effectively understand the provision of communication skills training (CST), this research identified CST courses for both medical and nursing students, and HCPs working with ABC patients.

CST courses were reviewed by top academic institutions across 12 countries, including the US, Mexico, Colombia, Brazil, the UK, Portugal, Spain, France, Poland, Nigeria, South Africa, India, China, Japan, and Australia (48 courses in total). In addition, courses were reviewed from 35 professional oncology organizations (e.g., European Society of Medical Oncology). Countries and CST courses were compared according to the target audience, thematic focus, accreditation, and any available metrics to measure engagement. The analysis focused on training that was specific to ABC where possible, however it also included breast cancer, and general cancer courses.

2.7. ABC Global Alliance member questionnaire

To examine ABC-associated advocacy activities, which included patient resources and awareness campaigns, a structured questionnaire was distributed to 95 member organizations of the ABC Global Alliance to identify informational gaps and areas of saturation.

The questionnaire collected data on: organizational information (n = 26 responses received), patient information resources developed since 2015 (n = 28 responses), and public awareness campaigns developed since 2015 (n = 33 responses). Some organizations provided information on multiple resources or awareness campaigns. A thematic analysis identified high and low content availability in submitted resources and campaigns.

2.8. Policy and funding analysis of support services

To evaluate the integration of seven critical support services (palliative and end-of-life care, social support, peer support, complementary and integrative medicines, wellness and lifestyle support, genetic counselling, and survivorship programs) national cancer control plans, government-led policies and cancer strategies from six countries (Brazil, France, Japan, South Africa, the UK, and the US) were analyzed for support service-related recommendations, specific to ABC, breast-cancer, and general cancer.

Funding for these services was analyzed using literature, claims data, and governmental reports where possible. This research focused on cross-country comparisons of service provision and funding mechanisms.

2.9. Social listening analysis

A social listening exercise was conducted to analyze online conversations about ABC to understand visibility, sentiment, and key themes in English-speaking countries. Brandwatch was used to monitor public online discussions from 2016 to 2024. Search queries targeted disease terminology (advanced breast cancer, metastatic breast cancer, secondary breast cancer, locally advanced breast cancer), advocacy groups, and comparative framing of ABC. The analysis was used to review conversation volume, sentiment, and recurring themes. It excluded private or restricted platforms and non-English content.

2.10. Economic targeted literature review

A targeted literature review aimed to understand the economic burden (e.g., out-of-pocket costs, direct/indirect costs) of ABC and evaluate economic analyses of ABC treatments over the last decade.

A systematic search on EMBASE was conducted using specific terms related to metastatic breast cancer, treatment types, and cost effectiveness outcomes. The search was limited to studies published between 2015 and 2024 with abstracts available. Inclusion criteria focused on studies reporting economic outcomes (e.g., cost-effectiveness, financial burden) in ABC patients. Exclusion criteria included case reports, editorials, non-economic studies, and publications before 2015. A total of 219 studies were included in the review.

2.11. Legal landscape analysis

The McCabe Centre for Law and Cancer conducted doctrinal legal research using publicly available information, legislation, and relevant case law, supplemented with input from local legal experts via a tailored survey. The research assessed key workplace protections for people living with ABC and their caregivers across 25 countries. Fourteen of these were priority countries identified by ABC Global Alliance, with the remaining 11 selected by the McCabe Centre aiming to represent a spread of different regions and income levels. India was excluded from detailed analysis due to ongoing legal reforms.

3. Looking ahead: A call to action

As we embark on the next chapter of the ABC Global Alliance's journey, the importance of collective global action cannot be overstated. ABC remains a challenge that is too complex for any single organization or country to tackle alone. Success will require sustained collaboration across sectors, from governments and healthcare providers to patient advocates and industry partners.

This special edition of The Breast delves deeply into the themes and findings of the Global Decade Report 2.0 (2015–2025) and 2025–2035 ABC Global Charter 2.0. Each article offers a unique perspective on the progress made and the work that lies ahead, representing each of the 10 goals of the new ABC Global Charter (Fig. 1). The ABC Global Charter 2.0 will guide the work of the ABC community in the next decade, aiming at further improving the lives of all people living with this disease worldwide and their families.

Fig. 1.

The ten goals of the ABC Global Charter 2.0 (2025–2035) [8].

For more detail, comprehensive methodologies, and further insights across the ABC landscape, please refer to the full Global Decade Report 2.0 (2015–2025) and ABC Global Charter 2.0 (2025–2035), available on the ABC Global Alliance website [11].

In closing, the ABC Global Alliance community and The Breast reaffirm their unwavering commitment to transforming the landscape of ABC care through implementation of the ABC Global Charter 2.0 goals.

Through collaboration, advocacy, and evidence-based strategies, we can create a future where every person living with ABC can live longer and better lives. Together, we can turn the tide against advanced breast cancer – one goal, one patient, and one decade at a time.

CRediT authorship contribution statement

Fatima Cardoso: Writing – review & editing, Writing – original draft, Validation, Supervision, Resources, Methodology, Funding acquisition, Formal analysis, Conceptualization. Roberta Ventura: Writing – review & editing, Project administration, Funding acquisition, Conceptualization. Georgia Attfield: Writing – review & editing, Writing – original draft, Validation, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Alexandra Lewis: Writing – review & editing, Writing – original draft, Validation, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Karen Gelmon: Writing – review & editing, Validation, Conceptualization.

Funding statement

The ABC Global Decade Report 2.0 (2015–2025) was funded by the ABC Global Alliance. The ABC Global Alliance received unrestricted educational grants from the Breast Cancer Research Foundation (BCRF), VML, Gilead, Menarini, Novartis, Pfizer and Roche as well as data contributions from AstraZeneca, Daiichi Sankyo, Gilead, Ely Lilly, Menarini, Merck, Novartis, Pfizer, PLMJ and Roche. These grants supported the research that shaped the report but none of the companies interfered in the scientific content. Some employees of the companies were invited to be members of the Scientific and Advisory Committee but as individuals and not representing their employer.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Given their role as author, [Editor-in-Chief] Fatima Cardoso and [Deputy Editor] Karen Gelmon had no involvement in the peer review of this article and had no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor.