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Rapid Responses: Rapid Responses published:
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Reduction in breast cancer mortality
- Graeme W Morgan (30 January 2005)
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Relative risk
- Alan C Gibbs (11 February 2005)
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Graeme W Morgan, Director, Radiation Oncology, Northern Sydney Cancer Centre Royal North Shore Hospital, Sydney NSW 2065 Australia
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Although no supporting data is given,the editorial (BMJ 28th January) suggests that adjuvant treatments with chemotherapy or hormones are more likely than screening to be responsible for reduction in breast cancer mortality, However, the reason(s) for the improved survival is much more complex than suggested. In the 1970's surgeons felt they 'owned' the patient and they were usually the only ones who decided which women had anything other than surgery. Nowadays there is an acceptance that overall management is best decided by a multidisciplinary team and that a number of persons - medical and non-medical - have a vital role in the management . This very basic change in the overall management of breast and other cancers has been overlooked in the rush to promote the use of adjuvant chemotherapy, although its benefit has been very much over-rated (1). The editorial also fails to give due credit to radiotherapy where there is now evidence that its omission post-mastectomy even after chemotherapy or hormones leads to unacceptable local relapse (2) and that there is an excess mortality (or loss of survival benefit) of 8.6% for women who do not receive radiotherapy after breast conserving surgery (3). As well as the 'medical' treatments much has been accomplished by para-medical services such as psycho-oncology, although the effect is more difficult to quantify. (1) Morgan G, Ward R, Barton, M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol) 2004; 16: 549 - 560. (2) Taghian A, Jeong J-H, Mamounas E et al. Patterns of locoregional failure with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project Randomised clinical trials. J Clin Oncol 2004; 22: 4247 - 4254. (3) Vingh-Hung V, Verschraegen C, for the breast-conserving surgery project. Breast-conserving surgery with or without radiotherapy: pooled analysis for risks of ipsilateral breast tumour recurrence and mortality. J Natl Cancer Inst 2004; 96: 115 -121. Competing interests: None declared |
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Alan C Gibbs, lecturer in medical statistics Centre for cancer epidemiology,Christie hospital trust.Manchester,M20 4QL
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The relative risk in mortality due to breast cancer in the population invited for screening in Copenhagen is 0.75 rather than 0.7 according to the paper by Olsen in the same issue. Perhaps a correction to this effect can be made in a later issue of the BMJ. Competing interests: None declared |
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