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UK sees steepest drop in breast cancer deaths

Breast cancer mortality falls faster in UK than in other European countries

Louise Prime

Thursday, 12 August 2010

The UK has experienced the steepest decrease in deaths from breast cancer of 30 European countries studied, research published today on bmj.com has shown. Experts say this paints a more realistic picture than recent figures appearing to show that the UK had the worst breast cancer survival in Europe.

Researchers from across Europe conducted a retrospective trend analysis of World Health Organization (WHO) mortality data on women dying from breast cancer in 30 European countries from 1980 to 2006. They found that population-based breast cancer mortality rates – especially among younger women – have fallen more steeply in the UK, in the past two decades, than in any other major European country.

The researchers used the WHO database to calculate mortality rates by women’s age (less than 50 years, 50-69 years and at least 70 years old). Over the study period, breast cancer mortality was steady or rose in central European countries. It fell by at least 20% in 15 countries; and by about 30% in the UK – the greatest drop of any other major European country. France, Finland and Sweden, which all invest heavily in screening and new cancer drugs, saw their mortality rates improve by 10-16%. The authors suggest that the decreases in mortality will continue.

Even though younger women (<50 years) are rarely screened for breast cancer, this age group showed the biggest reductions in mortality rates. The widespread improvement in mortality since the 1980s is largely ascribed to more effective treatment, and to screening and greater awareness of breast cancer leading to earlier diagnosis.

In their accompanying editorial, Valerie Beral and Richard Peto, from the University of Oxford, suggest why these results appear to fly in the face of recent claims that UK breast cancer survival is among the worst in western Europe. In many countries, cancer registration has been compulsory for decades, whereas in the UK it is not – so many surviving cases here never appear on any database. If death certificates are the only place in which breast cancer is recorded, they say, mortality rates can appear to be much higher in the UK than they really are.

“This makes short-term survival look misleadingly worse in the UK than in countries such as Sweden where, in contrast to the UK, cancer registration is compulsory and death certificates are not used for case finding,” they point out.

Professors Beral and Peto conclude that the findings in this study of a rapid decline in UK population-based breast cancer mortality rates in middle age are valid. They conclude: “International comparisons … need to take appropriate account of differences in the methods of cancer registration on which those calculations are based, and of any differences in cancer screening. Failure to make such allowances properly may well have led to misleading claims about the supposed inferiority of UK cancer treatment services in general.”

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