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Survival from breast cancer is lower in UK than in other developed countries

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1405 (Published 01 March 2013) Cite this as: BMJ 2013;346:f1405
  1. Jacqui Wise
  1. 1London

Women aged over 70 with breast cancer and women in all age groups with more advanced disease may be treated less aggressively in the United Kingdom than in some other countries, an international study indicates.

The research, conducted by the International Cancer Benchmarking Partnership and funded by the Department of Health for England, found that breast cancer survival was lower in the UK and Denmark than in Australia, Canada, Norway, and Sweden.1

The study used routinely collected data from cancer registries to monitor breast cancer survival in all women with breast cancer, not just selected groups. The researchers analysed data from 257 362 women who were given a diagnosis of breast cancer during 2000 to 2007.

Age standardised, net survival at three years was 87-89% in the UK and Denmark and 91-94% in the other four countries. One year survival varied from 94.3% in the UK to 98.4% in Sweden.

The low overall survival from breast cancer in Denmark was probably because of diagnosis at a later stage of the disease. Only 30% of women in Denmark had TNM (tumour, nodes, metastasis) stage I disease, whereas the proportion was 42-45% elsewhere. Denmark was the only country of the six not to have fully implemented a national breast cancer screening programme during the study period.

In the UK the proportion of women whose disease was diagnosed at an early stage was similar to that in most of the other countries, but survival was lower among women with more advanced cancers. Among women with stage IV cancers, three year survival was 28% in the UK but 42% in Sweden.

The authors said that this might be because women in the UK with advanced disease may not have been treated as aggressively as women in other countries.

The study found wide variations in survival among women in older age groups. In women aged 50-69 years three year survival was 96% in Sweden and 92% in the UK; in women aged over 70, however, survival was 91% in Sweden but only 79% in the UK.

Sarah Walters, from the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine, and the study’s lead author, said, “The reasons for low overall survival in the UK and Denmark are different. In Denmark, women are diagnosed with more advanced disease, but survival at each stage is similar to that in other countries. In the UK, women are diagnosed at a similar stage as elsewhere, but survival is lower than in women with the same stage of disease in other countries.

“The roll out of national mammography screening will be expected to improve overall survival in Denmark. In the UK, we should now investigate whether the treatment of women with later stage breast cancer meets international standards. There is particular concern that this is not the case, especially for older women.”

The UK also had the highest proportion of women with information about their cancer stage at diagnosis missing. This may be in part because in the UK the National Institute for Health and Clinical Excellence recommends that asymptomatic women should not undergo staging investigations such as whole body and bone computed tomography for metastatic disease.

Sara Hiom, Cancer Research UK’s director of early diagnosis, commented: “We know that UK women diagnosed with breast cancer are not routinely given CT scans to check if the disease has spread, which could mean we aren’t always accurately staging more advanced disease. But we also need to investigate the possibility that fewer women with later stage breast cancer in the UK receive the best treatment for their circumstances.”

Notes

Cite this as: BMJ 2013;346:f1405

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