Monday, 16 August 2010

Good, even better but not best

Now that the flurry of activity surrounding the publication in the British Medical Journal about breast cancer mortality statistics has calmed down, we need to look behind the headlines – “UK breast cancer rates fall faster,” “Breast cancer death rates dive,” and “Not so far behind Europe after all”.

It is all about the context. The research is good and the conclusions are thoughtful, but then the newspapers need a headline and a few punchy paragraphs and that is where the context disappears. In a nutshell, of course it is good news that mortality rates are continuing to fall and they have fallen the most in the UK. It isn’t such good news that our mortality wasn’t that great to start with.

The facts are that breast cancers in the UK are diagnosed earlier and treated more effectively than they were two decades ago and mortality has fallen.

What complicates things is that the quality of data relating to cause of death from the various countries in this study can be variable. As the study says data from, for example, Greece, Poland and Portugal should be considered with caution. Out of 28 countries (counting the devolved countries of the UK as one) there are the three already mentioned where the quality of data is “low” and 14 where it is “medium” (including France, Sweden and Germany) and only 11, including the UK and Ireland, where the quality is “high”.

The researchers have adjusted for all this so we can be confident that the trend is down but comparisons are not always reliable.

To go back to my starting point – we are better but what do we need to be best? Let’s be frank – best would be never to have to deal with breast cancer at all; next best would be cures for all the types of breast cancers – you are treated and then don’t have to think about it again. Is this realistic in the near future? Best for me would be early diagnosis and then effective treatments (without the worst side-effects) which can keep the disease at bay.

If that doesn’t sound very exciting – there are diseases we can’t cure but can treat effectively such as asthma as David Beckham, Ian Botham, Paula Radcliffe and Alice Cooper all know.

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