Thousands die needlessly from breast cancer Cancer surgeon says thousands die needlessly

BMA meeting: Plea for greater use of chemotherapy

Thousands of women are missing out on life-saving drug treatment for breast cancer despite incontrovertible evidence that it can reduce the spread of the disease and increase chances of survival.

The cure rate could be increased by as much as 30 per cent if more women were given chemotherapy early in the course of the disease, in addition to removal of the tumour, Margaret Gilchik, a surgeon from St Mary's Hospital in London, said yesterday.

However, more than half of women across all age groups treated in NHS hospitals still did not have chemotherapy. Mrs Gilchik accused some surgeons and radiotherapists of being lazy, and giving inappropriate or incomplete treatment because they failed to recognise breast cancer as a systemic (whole body) disease.

Britain has one of the worst rates of breast cancer in the world, and the spread of the disease from the primary tumour to the bone, liver and other organs is responsible for most of the 15,000 deaths each year.

Chemotherapy has been shown to wipe out the tiny "tumour seeds" - cancer cells which break off from the breast tumour and lodge in bone and elsewhere -in a majority of patients. A ground-breaking study by the Imperial Cancer Research Fund published in 1992 concluded that chemotherapy in early breast cancer would save thousands of lives worldwide.

But the emphasis has continued to be on surgical removal of the cancer and radiotherapy to wipe out any remaining cancerous cells in the breast, Mrs Gilchik told the British Medical Association's Annual Clinical Meeting yesterday.

About 25,000 women a year develop breast cancer, and about a third of cases are in pre-menopausal women. They tend to have more aggressive tumours and respond less well to surgery and radiotherapy than post-menopausal women, which is why early chemotherapy is vital in that group.

In addition, very few younger women benefit from tamoxifen, a hormonal drug which has been credited with the falling death rate from breast cancer in older women in recent years, although some doctors prescribe it anyway.

Mrs Gilchik said that all women with breast cancer, regardless of age, should receive chemotherapy except for those with small, localised tumours which had not spread from the breast to the lymph nodes. Aggressive triple therapy - surgery, chemotherapy and radiotherapy - was a treatment of choice.

Chemotherapy was associated with distressing side-effects, Mrs Gilchik said, but the worst, such as violent nausea and hair loss, could be reduced with other drugs or treatment.

The poor standard of treatment for breast cancer in British hospitals was a result of the disease falling between two specialities, surgery and radio- therapy. The role of the surgeon was declining and radiotherapists were developing into oncologists - cancer physicians with expertise in the administration of chemotherapy as well as radiotherapy.

"Radiotherapists are very much better now and breast specialists [surgeons who do only breast surgery] are going to make a big difference," Mrs Gilchik said. The development of cancer units across the country as centres of excellence serving smaller hospitals, as envisaged by the Calman Report, was also important.

Mrs Gilchik, one of only a handful of women surgeons in the country, also criticised the number of mastectomies still being carried out. A lumpectomy, followed by radiotherapy was at least as effective as removal of the whole breast, she said.