Our breast cancer failures let women die
Several years ago, the French government arranged an international meeting in Paris to discuss the latest treatments available to treat breast cancer. There were senior representatives from the ministries of health from the major countries in Europe, as well as many from farther afield.
There was one exception. Britain didn’t send any minister or other politician. We were represented by one junior civil servant, together with a bunch of journalists.
The omission had been noted by our hosts. A senior French government official, in his introductory welcome, suggested that Britain was always moaning about its relatively poor results in breast cancer treatment. But, he said, the reason for this was obvious: its authorities either didn’t know of, or didn’t care to provide, the best possible regime that would give an affected woman the best chance of survival.
We are catching up but still lag behind other countries, including those that are less prosperous than we are.
About ten years ago, I introduced the chairman of the American society that speaks on behalf of both the patients and those who look after them. In my welcome, I admitted that we couldn’t match his statistics that showed 95 per cent of the women who had followed his society’s recommended screening and treatment were apparently cancerfree for long enough for it to be a reasonable assumption that their period of remission could be regarded as a cure.
I was interrupted. Our guest was on his feet: ‘That’s wrong, Tom. It is not more than 95 per cent; it’s more than 96 per cent.’
The charity Breast Cancer Now has recently published a damning report (which I mentioned in the December issue of The Oldie). It suggests that, although the outlook for a British woman with breast cancer continues to improve, there are still many women in this country who are dying needlessly from it.
The British politicians and health officials, who determine our treatment of breast cancer, angrily retort by quoting the increase in government expenditure on breast cancer. This may be true but it doesn’t explain our poor survival statistics compared with other countries. In this country, nearly 12,000 women die from it annually.
Many overseas authorities think that our breast screening is inadequate. A three-year interval means that, if a breast cancer is missed at the first screening, it might have been present for up to six years before detection. In fact, by this time the patient will probably have had other symptoms and will already be destined for the unlikely-to-survive group. In some progressive countries, breast screening is recommended every 18 months.
The selection of women encouraged to have breast screening is also too limited. The older the woman, the more likely she is to have breast cancer, and yet these women are only screened if they request, even insist, on it.
Screening itself could be improved. In an ideal world, MRI scans would be useful, as standard mammography and ultrasound will pick up most cases.
The experience of both the radiologists and auxiliary staff is also important. The gap between the results recorded from the ‘best’ centres and the ‘run-of-the-mill’ centres is closing but still significant.
One problem is that there is likely to be a shortage of experienced radiologists within the next five to ten years. Another is that the number of women who are following even the relatively limited British breast cancer screening schedules is falling.
I have frequently disagreed with colleagues on medical priorities but, on one occasion, I did have a stand-up, ferocious argument with one professor of surgery who condemned the current spending of the breast-screening service on the grounds that it was predominantly serving the middle classes.
I suggested that, if in his area he had failed to reach the low-income groups, he should consider where he was going wrong – and make it clear that breast screening was lifesaving for women, whatever their income group or social class.
The Oldie