One in nine women in both Britain and the United States will fall victim to breast cancer at some point in their lives. So why are survival rates on each side of the Atlantic radically different? Madeleine Reiss investigates

Breast cancer treatment in both the US and Britain follows similar lines – what campaigner and writer Dr Susan Love describes as the ‘slash, burn and poison approach’ – surgery, radiation and chemotherapy, followed by hormone therapy. Yet figures for the five-year survival rate for breast cancer in the US stand at 85 per cent. In this country, it is just 67 per cent. That discrepancy, that missing 18 per cent, translates into millions of lives. Why? What does the American medical community offer that its British counterparts don’t? And what lessons are there to be learnt?

More aggressive
There are a whole host of clinical reasons for the dramatic disparity in figures, not least the fact that breast cancer treatment in America tends to be more aggressive, with an emphasis on early detection. American victims have quicker access to treatment and easier access to expensive chemotherapy. Some drugs still being considered in the UK by The National Institute of Clinical Excellence (NICE) – an organisation created to ensure best practice across the country – are already widely available in the US. These include drugs for advanced breast cancer.

Clinicians in the States also perform more biopsies on suspicious lumps and are known for their willingness to try out new treatments. Early detection is also a key element of their medical arsenal. Memorial Sloan Kettering in New York, considered to be the leading cancer hospital in America, recommends a mammogram every one to two years for women over 40 – plus an annual clinical examination and monthly self examination. In this country, mammograms are not offered by the NHS until women are 50, and then are only given once every three years.

Over the page: the American psyche

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

In addition to this new spirit of cooperation, the NHS?s `Cancer Plan? ? launched in 2000 has extended screening provision for women up to the age of 70 and introduced a maximum one-month wait from diagnosis to treatment. There is also now a maximum two week wait from GP referral to specialist outpatient appointment for those in whom a cancer diagnosis is suspected. The plan outlined plans for increased funding of cancer services over a 10-year period.

There’s still a long way to go however. Elizabeth Davies says: ‘An American oncologist would have major concerns about some of the things we do in this country.’

Drawbacks
However, while it may look rosy on the other side of the Atlantic, there are some drawbacks to such an active approach. A New York Times poll reveals breast cancer is the most feared disease among American women, even though strokes and heart disease kill far more. Some doctors fear this public awareness may lead to over-treatment, with women insisting on very aggressive therapies even when their cancers are small and slow growing.

Likewise, widespread testing for the BRCA1 and BRCA2 genes – thought to indicate a higher than average risk of breast cancer – may also be causing more problems than it solves. Although the testing is also available on a reduced basis in Britain (given to people already considered to be at a high risk of developing the disease), the indiscriminate testing in the States has been blamed for spurring people into making unnecessary choices. After all, being diagnosed with the bad gene is not necessarily an indication that you will go on to develop the disease. There is also the attendant risk that if you test positive for the gene, some insurance companies will cancel your policy.

Over the page: could we be better off?

Although newer and more aggressive treatment options are available in the US, many UK professionals in the field consider that the provision in Great Britain is as good as that on offer in the States. Janine Drennan, from The Cancer Research Campaign, says: ‘We may not be quite as fast as America at passing new drugs, but if, after vigorous testing over a 10 year period, a drug is found to be beneficial, then it will be used in the UK. There is no way that a new treatment would be withheld if it was in the best interests of women.’

One way in which Britain and America are alike, however, is that both countries suffer from patchy health care. A lot has been made of the British postcode lottery but the same can be said of the States. Women in New York, for instance, may have up-to-date treatment, but in Idaho it may well be very different picture. In addition to this, millions of American women cannot afford health insurance and their health care is, at best, very basic.

Undoubtedly the difference between UK and US pre-and post-treatments is costing lives. And the NHS is certainly under-funded. But here in Britain we have one distinct advantage over the American health system – every woman in this country is promised comprehensive treatment regardless of her ability to pay.