A question of geography

Although there has been debate about the reliability of mammograms for women under 50 – critics suggest the density of breast tissue at this age prohibits conclusive results – many American clinicians consider our screening programme to be totally inadequate. Indeed, the whole question of mammograms for women under 50 is currently being reviewed in this country and the situation may well change.

The American psyche
There may also be other non-clinical reasons for such a dramatic difference in figures. In the US, there is an established history of campaigning for money and research. The National Breast Cancer Coalition in Washington, a group of very vocal activist organisations, has succeeded in increasing investment in breast cancer research by $300 million in the last 10 years alone, incredibly getting a chunk of the national defence budget in the process. In this country we have been much more reticent about making our voices heard.

Things do finally seem to be changing in that regard. Over the last 18 months, the UK Breast Cancer Coalition, inspired by its American counterpart, has been crucial in bringing about a new willingness to listen to the demands of patients. Elizabeth Davies, chief executive of the UKBCC, says: ‘The whole issue of advocacy and campaigning is far better established in the American psyche than it has been in Britain. I feel this is changing now. This is partly because NHS policies state we have to speak to patients and involve them at the planning level. People are also more willing now to question their doctors and participate in decisions about their care.’

Over the page: cash, progress and drawbacks