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Beral and Peto respond to the rebuttal by Coleman et al [1] of their
editorial [2] that stated that UK cancer survival statistics were
misleading by emphasising that the UK is doing "comparatively well" by the
measure of breast cancer mortality. They are correct in this. When this
first became apparent more than a decade ago I suggested that the most
likely reason for the onset of this improvement in the late 1980s, as
shown in their figure, was the widespread use of adjuvant tamoxifen
initiated by breast surgeons in general hospitals [3].
They refrain from addressing Coleman and colleagues' core issue of
the validity of international comparisons of survival data derived from
cancer registries. Even with falling mortality the influence of a greater
proportion of UK patients dying in the first year after diagnosis, a group
of patients whose outcome cannot be affected by adjuvant treatment but
which is very likely to be related to the timeliness of their diagnosis,
is substantially to reduce the five-year survival [4].
It is very much to be hoped that their lack of comment on this point
indicates that those who are rightly proud of the NHS now acknowledge its
weaknesses as well as its strengths in caring for Britons who develop
cancer and that the necessary tasks of developing its services in a time
of parsimony can be supported by all of us[5].
References
1] Coleman MP, Rachet B, Woods L, Berrino F, Butler J, Capocaccia R,
et al. Rebuttal to editorial saying cancer survival statistics are
misleading. BMJ2011;343:d4214.
2] Beral V, Peto R. UK cancer survival statistics. BMJ2010;341:c4112.
3] Crawford SM. Cancer in the UK- A question of culture. Eur J
Cancer, 2000; 36: 1909-12
4] Henrik M?ller, Fredrik Sandin, Freddie Bray et al. Breast cancer
survival in England, Norway and Sweden: a population-based comparison. Int
J Cancer 2010; 127: 2630-8.
5] CRAWFORD SM Cancer care in the UK: updating the professional
culture. Postgrad Med J, 2011; 87:243-244.
Competing interests:
No competing interests
15 July 2011
S. Michael Crawford
Consultant Medical Oncologist
Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire BD20 6TD
Time to move on
Beral and Peto respond to the rebuttal by Coleman et al [1] of their
editorial [2] that stated that UK cancer survival statistics were
misleading by emphasising that the UK is doing "comparatively well" by the
measure of breast cancer mortality. They are correct in this. When this
first became apparent more than a decade ago I suggested that the most
likely reason for the onset of this improvement in the late 1980s, as
shown in their figure, was the widespread use of adjuvant tamoxifen
initiated by breast surgeons in general hospitals [3].
They refrain from addressing Coleman and colleagues' core issue of
the validity of international comparisons of survival data derived from
cancer registries. Even with falling mortality the influence of a greater
proportion of UK patients dying in the first year after diagnosis, a group
of patients whose outcome cannot be affected by adjuvant treatment but
which is very likely to be related to the timeliness of their diagnosis,
is substantially to reduce the five-year survival [4].
It is very much to be hoped that their lack of comment on this point
indicates that those who are rightly proud of the NHS now acknowledge its
weaknesses as well as its strengths in caring for Britons who develop
cancer and that the necessary tasks of developing its services in a time
of parsimony can be supported by all of us[5].
References
1] Coleman MP, Rachet B, Woods L, Berrino F, Butler J, Capocaccia R,
et al. Rebuttal to editorial saying cancer survival statistics are
misleading. BMJ2011;343:d4214.
2] Beral V, Peto R. UK cancer survival statistics. BMJ2010;341:c4112.
3] Crawford SM. Cancer in the UK- A question of culture. Eur J
Cancer, 2000; 36: 1909-12
4] Henrik M?ller, Fredrik Sandin, Freddie Bray et al. Breast cancer
survival in England, Norway and Sweden: a population-based comparison. Int
J Cancer 2010; 127: 2630-8.
5] CRAWFORD SM Cancer care in the UK: updating the professional
culture. Postgrad Med J, 2011; 87:243-244.
Competing interests: No competing interests