A DOCTOR WRITES:While too early to map Breastcheck's impact, it is clear making a range of drugs available has increased survival rates, writes DR MUIRIS HOUSTON
THE PUBLICATION in the British Medical Journal of a large study on breast cancer mortality in Europe offers an interesting comparison with how the Republic is performing in providing care to women with the common cancer. Almost 3,000 cases are diagnosed here each year.
The good news from the study is the 26.4 per cent reduction in deaths from breast cancer here between 1989 and 2006.
This compares with a European average of 19 per cent. Iceland performed best with a 45 per cent drop in mortality; in some east European countries, death rates from breast cancer actually increased.
With the study by the International Agency for Research on Cancer (IARC) finding our mortality reduction began in 1991, what can be said about the reasons for the decrease?
Unfortunately, we cannot give much credit to Breastcheck, the national screening service for women aged 50 to 64. It became fully operational just last year, and would have had little impact on mortality figures for the years leading up to 2006.
But we can salute the greater availability of new treatments for breast cancer.
In particular, the rapid approval of new chemotherapy agents by regulators here and the lack of any form of “postcode lottery”, such as existed in the UK, that might have restricted access to new drugs.
In particular, we should acknowledge the role of hormonal treatments such as tamoxifen, the long-term use of which has prevented many cases of breast cancer recurrence.
The greater availability of radiotherapy in latter years also contributed.
As well as the impact of Breastcheck, we can look forward to further reductions in mortality from the reorganisation of cancer services leading to a multidisciplinary and triple-locked approach to diagnosis and treatment.
But greater screening is likely to increase the incidence of breast cancer due to a greater detection of smaller and less aggressive cancers.
The relatively poor figures for France are notable: the country has invested heavily in spending on cancer drugs and has one of the highest number of mammography units per million women.
It has also devoted much effort to enhancing adherence to recommended treatment guidelines.
According to yesterday’s figures, it has been poorly rewarded for its efforts.
There has been some speculation that a national preference for so-called “natural progesterone” as a form of hormone replacement therapy may have contributed to a higher incidence of breast cancer in France but there is no scientific evidence to support this.