Up and down the country this month thousands of people will be wearing pink, baking cakes and taking part in sponsored activities to raise money and increase awareness as part of breast cancer awareness month. For decades UK breast cancer charities have funded research, raised awareness, supported patients and tirelessly campaigned for improvements to breast cancer services. From being a disease associated with stigma, breast cancer has become a cause, and a fashionable one at that.
The transformation in its public profile has been accompanied by significant improvements in services. Breast cancer screening programmes and access to better treatments have helped breast cancer five year survival rates in England improve from around 50% in the early 1970s to over 80% today.
Sadly, however, over 12,000 women a year in the UK still die from breast cancer – and due to steadily rising incidence – this figure is unlikely to fall in the very near future. But while breast cancer survival rates have improved over recent decades, how England’s cancer survival rates compare with Europe is still a matter of political controversy. Debates during the last election in particular saw the parties fighting it out over whether significant progress had been made recently or not.
So how do England’s breast cancer survival rates compare with Europe? The problem with answering that question definitively is that data looking at survival rates across Europe are quite out of date, and where they do exist, there are complicating issues with whether the figures are comparable due to differences in the way they are collected.
The last comprehensive analysis of cancer registry data Europe-wide, EUROCARE-4, was published in 2007. This study included looking at breast cancer survival rates for patients diagnosed in the period 2000-2003, which showed England had a five year survival rate of 77.8% compared with a 79% European average. This figure becomes more disappointing however when compared with survival rates in Nordic countries, such as Sweden which had survival rates around the 85% mark. The figure also hides variation across England – other data shows that some PCTs had one year survival rates in 2006 that were below the European average in 1995-1999, a very poor result given that the European average is highly likely to have improved in the interim.
A new project linking clinicians, policy makers and academics, the International Cancer Benchmarking Partnership,is starting to provide more answers about how and why cancer survival rates vary internationally. Initial findings from this project published in The Lancet suggest that the gap between breast cancer survival rates in the UK and other countries may be narrower than for other cancers.
Although there remains some distance to go to ensure breast cancer survival rates in the UK are amongst the best in Europe, it is undeniable that significant progress has been made. So what lessons can be learnt from the ‘breast cancer experience’ for other conditions that might want to raise their profile and improve patient outcomes?
Firstly, research is vital. Without research, improvements to diagnosis, new ways of delivering services and new treatments simply won’t be discovered: research into breast cancer has certainly paid off. Next, of course, where clinically effective treatments exist patients must have access to them, which is why the Cancer Drugs Fund is such an important development. Equally, the main way of ‘curing’ breast cancers is still surgery. Advances in surgical technique mean less invasive procedures are possible, and it is important that these techniques are made widely available.
Secondly, for patients with progressive conditions, early diagnosis is key to improving patient outcomes. Breast cancer advocates were right to focus in the beginning on raising awareness of breast cancer, working to ensure implementation of the NHS breast screening programme and encouraging uptake.
Thirdly, never underestimate the importance of campaigning. Breast cancer patients have benefited from campaigns that realised key calls need to be focused and easily-understandable by a range of stakeholders. It quickly become widely accepted, for example, that breast screening needed to be effectively implemented and women encouraged to take part and that breast cancer patients should have access to the best treatments available. Because every politician understood and echoed these statements, it helped to increase pressure on the government and the NHS to deliver.
These campaigns have also help to raise the profile of issues that affect other conditions – the discovery of under-treatment of older women with breast cancer based on their chronological age rather than clinical status, for example, has helped to draw focus to the under-treatment of older patients across a range of conditions.
Fourth, create a community. Breast cancer now benefits from a high profile that allows it to more easily gather celebrity and stakeholder support – thereby creating a snowball effect. But breast cancer organisations did not start out with this high profile. They did however recognise the importance of creating a community amongst their supporters – bringing in the families of those affected by breast cancer and their friends with activities that are easy to take part in, but by wearing something pink or cheering on a friend at the end of a marathon, gave thousands of people a stake in the cause.
Finally, breast cancer advocates have recognised the need to find a delicate balance between hope and fear in their messaging. Without hope, individuals are likely to simply want to avoid thinking about the possibility of breast cancer and so it is important to emphasise progress. Equally, fear for your and other’s health can also be highly motivating and highlights the need for further action.
Progress in breast cancer, to a degree, threatens to become a limiting factor. When advances are highlighted, there is a risk that key stakeholders may start to think that sufficient improvements to breast cancer services have already been made and that they do not need further attention. This month, for the nearly 50,000 women diagnosed with the disease every year in the UK, we will be reminded that further progress is still very much needed.