Improving equitable access to comprehensive care for people with advanced breast cancer: a global expert review and call-to-action for 2025-2035 (Goal 9).

Advanced breast cancer (ABC) remains an incurable yet treatable disease, requiring lifelong care. While treatment advancements have extended survival for many patients, access to these innovations is far from universal. There remains a critical need to ensure equitable access to proven and established interventions for all individuals with ABC, while continuing to drive progress in care and survival outcomes. This manuscript assesses the evolving economic landscape for and access to comprehensive ABC care since 2015. It describes the persistent access barriers and inequities, and outlines recommendations for the ABC community over the next decade. It summarizes research conducted for the ABC Global Alliance's Global Decade Report 2.0. The main findings are: a) Disparities in access to ABC care are widening globally; b) Variable access to diagnostic services delays timely and adequate ABC treatment; c) Infrastructure, supply, and reimbursement barriers hinder ABC treatment access; d) High out-of-pocket costs drive severe financial toxicity across all income settings; e) In low-income contexts, multi-stakeholder efforts are improving access to ABC care. The findings from the ABC Global Alliance's Global Decade Report 2.0 have informed the development of a new ABC Global Charter. The ABC Global Charter 2.0 defines ten new achievable and measurable goals for the decade 2025-2035, aiming at improving the lives of people living with ABC worldwide.