Worldwide, just over half a million people die each year from breast cancer. That is too many women and men, so further progress is needed to reduce, or even eliminate, this unwelcome premature mortality. But rising drug prices are putting such pressure on healthcare systems that medicine regulators, health economists and clinicians are focusing on how costs can be contained to create affordable and sustainable models for the future. In the main interview of the newsletter, Jenny Bryan discusses recent US and European initiatives and reports industry and patient advocate viewpoints on the way forward.