Health
“Breast cancer treatment is still a zip code lottery with too low survival in the UK”-Miriam Stoppard
I remember my first breast cancer case to this day. She was a 33-year-old young woman who was very angry at the possibility of losing her breasts.
Yes, at that time, inhumane surgery for total mastectomy was still routine and was the surgeon’s choice of treatment I was an apprentice. At that time, I was convinced that it was cruel.
There have been many changes since then, but one has not. Treatment of early-stage breast cancer remains a zip code lottery, leading to poor outcomes, especially in older patients.
One in seven women develops breast cancer, and the outlook is much better than in my time.
More people have been diagnosed and mortality continues to decline, with nearly 80% of women diagnosed with breast cancer living 10 years later. This is mainly due to early diagnosis and more effective treatment.
Nonetheless, David Dodwell, a senior clinical researcher at Oxford University, and his colleagues say there is still room for improvement.
Survival rates in the United Kingdom still lag behind those in countries such as the United States and Australia.
There are many different strategies for treating breast cancer. Breast-conserving surgery is often preferred over mastectomy (removal of all breast tissue). This is because they have the same effect, but the former has a better quality of life.
Surgery remains the most important treatment for early-stage breast cancer. However, it is not so easy to achieve, as shown in a national audit of breast cancer in older patients.
Surgery rates vary greatly. Between 2014 and 2016, it was accepted by 85% to 100% (average 96%) among women aged 50-69. However, this dropped from 46% to 97% (76% on average) over the age of 70. The choice of treatment, such as hormone therapy or chemotherapy, depends on the type and spread of the cancer cells and the risk of recurrence.
For example, ER (estrogen receptor) -positive cancer patients are treated with endocrine therapy, and HER2- (human epidermal growth factor receptor 2) -positive patients are usually treated with chemotherapy (trastuzumab).
Although there are good trials that provide good evidence of the best treatments, they still deviate from best practices and may be one of the factors behind poor survival.
Things haven’t improved. This photo is almost the same as it was about 20 years ago. At that time, clinical outcome measurement audits for breast cancer reported mastectomy rates ranging from 36% to 53% at the regional level and 19% to 92% at the individual surgeon level.
Why didn’t we do this right?
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