A Tale of Two Patients: Paula and Pippa
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Same diagnosis. Different countries.
Very different outcomes.
Paula lives in Chicago. Pippa lives in Manchester. Both were diagnosed with the same type of breast cancer in 2026 but have very different access to treatment and outcomes because of where they live.
Paula
52 years old
Chicago, Illinois
Paula noticed a lump in her breast and saw her doctor straight away. Tests confirmed she had HER2-positive breast cancer that had already spread to her liver and bones, or stage 4 metastatic breast cancer.
She has private health insurance through work.
Pippa
52 years old
Manchester, England
Pippa also noticed a lump and went straight to her GP. After tests, she was given the same diagnosis as Paula: HER2-positive breast cancer that had spread to her liver and bones.
She is a National Health Service (NHS) patient.
HER2 is a protein that sits on the surface of some breast cancer cells and makes them grow faster than normal. About 1 in 5 breast cancers have too much of this protein, called HER2-positive breast cancer.
50,000 to 60,000 new HER2-positive patients are diagnosed each year in the US.
New drugs that specifically target HER2 have transformed outcomes for this type of cancer, but due to regulatory restrictions and slower timelines in the EU, innovative drugs are often only accessible in the U.S. In the UK, 30% of women survive for 5 years or more after they are diagnosed with HER2 positive breast cancer. In the U.S., 5-year survival exceeds 45%.
But how is this drastic of a difference possible?
Getting a Diagnosis
Both Paula and Pippa noticed their lump at roughly the same time. Here is how long it took each of them to get a diagnosis confirmed and start treatment:
Paula
Pippa
Week 1
Saw her doctor, had a mammogram and ultrasound, and was referred to a breast specialist — all within one week.
Week 1
Saw her GP, who referred her urgently for a mammogram.
Week 2–3
Had her biopsy. The HER2 test sometimes requires an additional test, called FISH, to confirm diagnoses. Still, Paula got her full results back — including the secondary FISH HER2 test if needed — within 7 to 10 days.
Week 2–3
Had her mammogram within two weeks. Despite the NHS targeting a maximum 28-day window from urgent GP referral to confirmed diagnoses or all clear, only 55% of breast cancer patients received their confirmed diagnosis within that timeframe in 2024.
Week 4–5
Within the month, Paula has already had body scans to check where the cancer had spread, met her personalized cancer team, and started treatment.
Week 3–6
Had her biopsy, but the biopsy results will take 1 to 2 weeks to process. In the UK, the secondary FISH test can take an extra week. This can significantly delay treatment.
Total: About 4 to 5 weeks from noticing the lump to starting treatment.
Week 6–10
For Pippa, it takes more than a month just to complete body scans, meet with her cancer team, and finalize a treatment plan. Notably, NHS also faces a shortage of radiologists — the doctors who read scans — which adds further delays.
Total: 10+ weeks — More than twice as long as Paula.
The UK has a goal of cancer treatment starting within 8 weeks of first referral but meets that goal less than 70% of the time.
Research shows that for HER2-positive breast cancer, delays in starting the right targeted treatment of more than six weeks from diagnosis are linked to significantly higher rates of the cancer returning and lower survival.
Every week matters.
Courses of Treatment
This is where Paula and Pippa's experiences become starkly different, as the medicines available to them are not the same. While Paula has consistent access to the latest innovative medicines, Pippa faces aggressive cancer with older, less effective tools.
Starting Treatment
(First-line Therapy)
Paula
A new drug combination was approved in the U.S. in December 2025, Enhertu plus pertuzumab. In a large clinical study, this combination therapy delayed cancer progression by more than three years on average, about one year longer than those receiving the previous standard treatment.
This is currently the most effective first-line treatment available for her type of cancer anywhere in the world.
Pippa
A combination called THP — docetaxel, trastuzumab and pertuzumab. This was the best available treatment when it was approved more than a decade ago.
If Pippa were to receive Enhertu + pertuzumab like Paula, it would reduce the risk of cancer progression by 44% compared to the THP treatment.
Enhertu + pertuzumab has not yet been approved for use in the UK. After receiving marketing approval, the medicine will need to be evaluated for pricing and reimbursement by the NHS. As a result, it will not be available for several years.
When the Cancer Starts Growing Again
(requiring second-line therapy)
Enhertu is standard second line treatment in the U.S.
Paula may also be eligible for innovative clinical trials testing the next generation of cutting-edge treatments
Enhertu is approved for use in the UK, but is not covered by the NHS where Pippa lives because the UK has not set a price for the treatment that allows broader coverage.
Pippa may apply to the UK’s Cancer Drugs Fund, which allows time-limited access to medicine to a select few patients. NHS also limits coverage based on a scale rating of the patient’s health status and frailty. In the UK, Enhertu is typically only accessible to those with the least serious disability due to illness. Other patient-specific requirements also limit access.
If her cancer spreads to the brain later, tucatinib (combined with two other drugs) is also NHS-approved.
What Does This Mean for Paula and Pippa?
Pippa missed out on the stronger first-line treatment Paula received and will likely not have access to the more effective second line therapy either when her cancer returns. These barriers to access impact her treatment outcomes compounding the harms from delays in access to diagnosis and treatment start.
With the newest drugs available in the U.S., the average person with HER2-positive breast cancer, like Paula, now lives more than 5 years after being told their cancer is stage 4. For some, it is much longer, offering valuable additional time with family and friends.
With HER2-positive metastatic breast cancer, every moment matters. Every day lost due to ineffective regulations is precious time for patients. For those in the UK, lack of accessibility to innovative treatments means lower 5-year survival rates, less time spent in health, and less time with loved ones.
More information on what "Most Favored Nation" drug pricing means for the U.S.
Sources
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ii. Survival for Breast Cancer. https://www.cancerresearchuk.org/about-cancer/breast-cancer/survival. Accessed 19 June 2026.
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vi. Tolaney, Sara M., et al. “Trastuzumab Deruxtecan plus Pertuzumab for HER2-Positive Metastatic Breast Cancer.” The New England Journal of Medicine, vol. 394, no. 6, Feb. 2026, pp. 551–62. PubMed, https://doi.org/10.1056/NEJMoa2508668.
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