Breast cancer plan to save 4,000 lives a year

Commons committee criticises UK record on treatment and proposes radical overhaul

LIZ HUNT

Medical Correspondent

A radical overhaul of breast cancer services designed to prevent at least 4,000 unnecessary deaths each year was unveiled by the Commons Health Select Committee yesterday.

In a hard-hitting report, the committee says the United Kingdom's poor survival rates for the disease - among the worst in the world - are due in part to inadequate treatment.

It urges the Government to fund research into why the record is so poor and "in particular to investigate the possibility that the disease in this country runs a more aggress- ive course than it does elsewhere". The committee, which took evidence from more than 70 doctors, nurses, patients and charities, highlights the regional differences in treatment. Drug therapy for breast cancer is offered to 40 per cent of patients in York but fewer than 25 per cent of patients elsewhere in Yorkshire. Sixty per cent of patients in Hull, Pontefract and Wakefield undergo radiotherapy compared with only 20 per cent in Bradford.

Dr Len Price, a cancer specialist, told the committee "approximately 4,000 women are dying every year because they are not given treatment proven to be effective . . . The use of adjuvant chemotherapy and hormone therapy in 'bad risk' patients has already saved more lives over the last 15 years than any other single measure in the history of cancer medicine. Regrettably, most patients in the UK who might benefit from it never receive it."

Each year there are 26,000 new cases of breast cancer and 15,000 deaths from the disease. Women who are treated in specialist centres by breast cancer experts survive longer than those treated in smaller hospitals by general surgeons.

The committee recommends that all women with breast disease should be treated in specialists units by a multi-disciplinary team of breast experts, from radiologists to nurses. Units should publish data relating to their clinical practice and its outcome so that the best centres and best practice can be readily identified.

The report commends the National Health Service breast screening programme, which monitors women aged 50 to 64 every three years. However, it says the Government must guarantee national funding for the scheme's quality assurance programme so that it is independent of purchasers and providers of breast services. It also urges the Government to extend screening to include women up to 69 after Swedish studies suggested it could save lives, and says that women with a genetic predisposition to the disease should be considered for screening under 50.

The committee said it welcomed the Government's own proposals for improving cancer services published in April last year. This envisages a three-tier system of cancer care; a primary-care team providing the focus of care, with designated cancer units in most district hospitals treating the commoner cancers, and designated cancer centres in larger hospitals, offering more specialised treatment of common and rare types of cancer. However, the report says that a system of audit for the centres must be implemented.

Clinical research into breast cancer could be improved by issuing funds through one central body rather than the current piecemeal fashion, by the Department of Health, the Medical Research Council and charities.

Hugh Bayley, Labour MP for York and a member of the committee, said: "More women get breast cancer in America but fewer die from it because they get better treatment. Our government has no chance of reducing breast cancer deaths in Britain by 25 per cent by the end of the decade if it does not adopt many of the radical ideas in our report."

nBreast Cancer Services, Health Committee, Third Report, is available from HMSO price pounds 13.25.