Good News from the UK
A recent article in the British Journal of Cancer is a commentary about "Survival from breast cancer in England and Wales up to 2001" by Leary and Smith. There are several studies reported in the same issue of the Journal (2008) 99). Here are the highlights:
ADVANCES IN THE TREATMENT OF METASTATIC BREAST CANCER
A number of new cytotoxic, endocrine and targeted agents have been licensed for breast cancer over the last 15 years and have greatly increased treatment options for advanced disease (Smith, 2002). Although the impact on overall survival trends is likely to be modest, the incorporation of these new therapies into clinical practice has been shown to significantly prolong survival from metastatic breast cancer (OS from metastatic breast cancer: 438 days vs 667 days for women treated in 1991-1992 vs 1999-2001; Chia et al, 2007). By increasing the number of effective anti-cancer agents, and improving palliative strategies by offering radiotherapy
for symptomatic bone and brain lesions, or surgical treatment of spinal and brain metastases, tremendous gains have been achieved in improving both the quality of life and survival of women with advanced breast cancer.
THE DEPRIVATION GAP
Quinn et al (2008) draw attention to the observation that although the incidence of breast cancer has risen more rapidly among affluent women, the deprivation gap (difference in survival from breast cancer for women from affluent vs deprived background) has not changed. This may in part be due to the fact that women from a higher socioeconomic background are more likely to >undergo mammography and therefore be diagnosed with a small screen-detected breast cancer (Taylor and Cheng, 2003). However, as Quinn et al (2008) point out, if screening were the sole reasonfor the increased incidence, this should have led to a stage shift in the affluent group and a widening in the deprivation gap. Women of higher socioeconomic status are also at increased risk of developing invasive breast cancer due to differing reproductive behaviours of aetiological significance, for example, late age at first birth, low parity, and low breastfeeding rates (Kelsey et al, 1981). The incidence trend may therefore also reflect changes in reproductive habits and possibly in the use of hormone replacement therapy among affluent women.
Improvements in breast cancer diagnosis and treatment in the UK have had an important impact on survival, and it is reasonable to expect that the outlook will continue to improve over the next decade. Governmental guidelines implemented in the late 1990s designed to reduce delays and improve multidisciplinary organisation and the continuing development of more effective medical therapies are both making important contributions. The political challenge is to ensure equal access to best care for women from deprived backgrounds. The medical challenge is to select through molecular profiling which patients are most likely to benefit from the ever-expanding medical treatment options and which can be spared unnecessary toxicities. The good news is likely to continue.
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