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Breast Cancer Mortality Decline in Younger Women: A Paradigm Shift for Healthcare Investors

Albert FoxFriday, May 2, 2025 7:33 am ET

148min read

The American Association for Cancer Research (AACR) recently reported a dramatic decline in breast cancer (BC) mortality among women aged 20–49 between 2010 and 2020, driven by breakthroughs in precision medicine and expanded screening programs. This shift, highlighted in a study led by Adetunji Toriola, underscores a transformative era in oncology and presents compelling opportunities for investors in pharmaceuticals and healthcare technology. Let’s dissect the trends, their implications, and the companies poised to lead this revolution.

The Science Behind the Decline

The mortality drop—from 9.70 to 1.47 per 100,000 women—stems from two key advancements:
1. Precision Medicine: Targeted therapies, such as CDK4/6 inhibitors and endocrine treatments, have improved survival rates, particularly for hormone receptor-positive (HR+/HER2−) subtypes.
2. Screening Expansion: Policies lowering the recommended screening age to 40 (via the U.S. Preventive Services Task Force) and advanced imaging technologies like digital breast tomosynthesis (DBT) have enabled earlier detection.

Pharmaceutical Leaders in Precision Oncology

The development of CDK4/6 inhibitors stands out as a cornerstone of this progress:

Eli Lilly (LLY): The Pioneer of Abemaciclib

Eli Lilly’s abemaciclib (Verzenio®) has been pivotal, approved for both metastatic and early-stage HR+/HER2− breast cancer. Its MONARCH series of trials demonstrated life-extending efficacy, while the 2020 NMPA approval for China’s market underscores its global reach.

Key Metrics:
- Abemaciclib’s sales grew to $1.4 billion in 2023, with high-risk early-stage breast cancer (monarchE trial) expanding its addressable market.
- The drug’s unique CDK4 selectivity offers a competitive edge over rivals like Pfizer’s palbociclib (Ibrance®), reducing neutropenia risk.

Pfizer (PFE) and Novartis (NVS): Established Players

Pfizer’s palbociclib, the first-in-class CDK4/6 inhibitor, remains widely used in combination with endocrine therapies. Novartis’ ribociclib (Kisqali®) also holds a strong position in pre- and postmenopausal patient populations.

Jiangsu Hengrui (6856.HK): China’s Rising Star

Hengrui’s dalpiciclib (Shr6390) targets the growing Asian market, where accessibility and affordability are critical. Its 2020 approval in China positions it to capitalize on rising breast cancer incidence in the region.

The Screening Tech Revolution

Screening advancements are equally critical. The U.S. breast cancer screening market is projected to grow from $1.55 billion (2024) to $2.34 billion (2030), driven by:

Digital Breast Tomosynthesis (DBT): Accounting for nearly 50% of imaging procedures, DBT reduces false positives and improves detection in dense breast tissue.
AI Integration: Tools like iCAD’s ProFound AI and GE Healthcare’s cloud-based platforms enhance diagnostic speed and accuracy.

Hologic (HOLX): The Market Leader

Hologic dominates with ~70% of the U.S. mammography market. Its Selenia Dimensions DBT systems are in high demand as policies expand screening to younger women. Q1 2025 revenue surged 36% year-over-year, reflecting the policy-driven boom.

Why Investors Should Take Note:
- The NCQA’s HEDIS guideline expansion (40–74 years) could add 1.6 million mammograms annually, requiring ~1,020 new systems.
- Hologic’s AI partnerships (e.g., with CancerIQ) and global reach (49.93% DBT market share) solidify its dominance.

Equity Implications: Winners and Risks

Top Picks:
1. Eli Lilly (LLY): Abemaciclib’s expanding indications and global approvals provide durable growth.
2. Hologic (HOLX): Primed to capitalize on screening policy changes and DBT adoption.
3. iCAD (ICAD): AI-driven diagnostics could see surging demand as early detection becomes a priority.

Risks:
- Regulatory Hurdles: Continued scrutiny of drug pricing and access could pressure margins.
- Technological Competition: New entrants in AI and liquid biopsy (e.g., Grail by Danaher) may disrupt traditional imaging.

Conclusion: A Multi-Billion Opportunity

The decline in breast cancer mortality among younger women is not just a medical triumph but a catalyst for sustained growth in healthcare sectors. With precision oncology markets projected to hit $25 billion by 2030 and screening demand surging, investors should focus on:

Pharma Innovators: Eli Lilly and Hengrui, leveraging CDK4/6 inhibitors and regional access.
Tech Leaders: Hologic and GE Healthcare, driving DBT and AI adoption.

The data is clear: the combination of targeted therapies and advanced diagnostics is rewriting survival outcomes—and the companies leading this charge are positioned for decades of growth.

In this new era, investors ignoring these trends risk missing out on one of the most compelling healthcare narratives of our time.

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