Older breast cancer patients are not receiving a full range of treatment options, according to a report published in the British Journal of Cancer.
Data from the Breast Cancer Clinical Outcome Measures (BCCOM) Project, a pioneering audit of breast cancer treatment funded by Breakthrough Breast Cancer, also suggests regional differences in breast cancer care.
This is the first time that statistics on the treatment of symptomatic breast cancers in the UK have been brought together and analysed, and the results show that older women across the UK are less likely to receive standard treatments such as chemotherapy, radiotherapy or surgery than younger women with a similar diagnosis. Just 16% of patients over 65 received chemotherapy, compared with 77% of patients under 50.
Researchers at the West Midlands Cancer Intelligence Unit, who collected and analysed the data, also found that:
- 48% of women aged 80 and over did not receive any type of surgery, compared with just 3.5% of women under 50.
- Older women who did receive surgery were more likely to have a mastectomy. Only 42% of women aged 65 and over received breast conserving surgery, compared with 51% of women under 65.
- Only 31% of patients over 80 received radiotherapy, compared with 78% of patients under 50.
The report also highlights regional variations in the treatment breast cancer patients are receiving. Data were submitted by all 11 UK cancer registries, and, although the number of surgeons participating varied across the UK, there still appear to be differences between regions, particularly in whether patients had a mastectomy or less invasive breast conserving surgery. In the Trent Cancer Registry region (covering South Yorkshire, Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire and Rutland) as many as 42% of reported cases with an invasive breast tumour smaller than 15mm, had a mastectomy rather than breast conserving surgery. Although some patients may choose to have a mastectomy, these figures are higher than can be explained through patient choice alone.
Guidance on the diagnosis and treatment of breast cancer from the National Institute for Health & Clinical Excellence (NICE) was published in February 2009 which sets out best practice standards of care across England and Wales, alongside guidelines from the Scottish Intercollegiate Guidelines Network (SIGN). Breakthrough hopes breast units across the country will review their own practices in light of the BCCOM Project data and these guidelines.
Maggie Alexander, Director of Policy & Campaigns at Breakthrough Breast Cancer, says:
"Breakthrough is concerned that there appear to be significant differences in treatment given to patients depending on their age. While older patients may be less likely to receive standard treatment, possibly due to patient choice or the underlying health of an individual, we need to better understand all the reasons why. All women should be offered appropriate treatment options no matter what their age and that's why we are now investigating this issue to find out what lies behind these differences.
"We hope that healthcare professionals will use these data to consider their own services and to review any areas which differ widely from other regions or clinical guidelines. Anyone concerned about their breast cancer treatment should talk to their doctor."
Dr Gill Lawrence, Director of the West Midlands Cancer Intelligence Unit, who led the project, says:
"This audit provides valuable national data on breast cancers which are detected symptomatically. By improving the quantity and quality of the information collected on the treatment of these breast cancers we can improve the quality of care for patients. We encourage breast units to review their services and to identify ways in which they can be improved. Although the data in this report are for breast cancers diagnosed in 2004, we are confident that the data highlight many issues which still exist today."
"It is essential that we continue to collect and analyse data on breast cancer treatment in the UK in order to build an even clearer picture of breast cancer services and continue the drive towards the best possible services for all."
Mr Hugh Bishop, Consultant Breast Surgeon, Royal Bolton Hospital NHS Foundation Trust says:
"The data from the BCCOM Project provide surgeons with an excellent opportunity to gain insight into how their services compare with others around the UK and to consider how the care they offer could be improved. Collecting data on the treatment we provide is vital if we are to continue to develop and improve services. By submitting data to the BCCOM Project, surgeons can make a real contribution to this crucial work, and I would encourage all surgeons to take part in the study."
The BCCOM Project asked surgeons from hospitals covered by the UK's 11 cancer registries to report on the diagnosis and treatment of all breast cancer cases detected symptomatically. Researchers at the West Midlands Cancer Intelligence Unit collected and analysed the data in order to provide a national audit of the diagnosis and treatment of symptomatic breast cancers. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Notes
The Breast Cancer Clinical Outcome Measures (BCCOM) Project
The BCCOM Project aims to collect high quality data on breast cancer cases in order to compare current practices and clinical outcome. This important study has the potential to improve disease management and improve breast cancer service provision across the UK.
The BCCOM project aims to develop mechanisms to improve the collection of data for symptomatic breast cancer and to audit the management of these cancers in the UK. The data are obtained by tapping into existing sources such as the data currently collected by cancer registries. These data are then analysed to generate information on the clinical outcome of individual breast services. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise. The data collected are fed back to participating surgeons and also to the wider breast management team. This unique collection of data could improve breast cancer service provision and patient outcomes.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Source
Breakthrough Breast Cancer
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