Cancer deaths in Britain `no worse than elsewhere'

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The Independent Online
THE CHIEF of cancer services in Scotland yesterday challenged claims that Britain has one of the worst records in the Western world for survival from the disease.

Dr Harry Burns, lead clinician for cancer in Scotland - the equivalent of England's newly appointed cancer tsar - said that figures showing higher death rates for Britain than Europe and America were not comparing like with like.

Britain comes close to the bottom of the European cancer league according to the Eurocare II study, the latest available, and its poor performance has been widely criticised. But the system for registering cancer deaths is much tighter in Britain than elsewhere. A cancer patient who dies of a heart attack will be registered as a cancer death in the UK, while other countries' cancer registries tend to understate their death rates, Dr Burns said.

Eurocare II throws up oddities which cast doubt on the validity of the figures. The study, showing five-year survival rates from 1978 to 1989 for 17 countries, suggests Estonia has the best rate for certain cancers, above that of prosperous Germany and France. It also shows that immigrants to Switzerland have a higher survival rate than the resident population - because most return to their home countries in their final months and their deaths are not recorded.

Separate evidence from international trials shows that British patients included in the trials do just as well as patients from other countries, casting doubt on the claims that treatment is less good in Britain.

Dr Burns, who is director of public health for Glasgow, said the vogue for denigratingBritain's cancer services was bad for morale. On Monday, 300 oncologists meeting in London at a conference organised by Eli Lilley, the pharmaceutical company, claimed cancer patients in Britain were getting a "Third World service".

Dr Burns said: "Until we have a properly designed study comparing like with like, it is daft and demoralising to say we do badly. There is no evidence that British patients are dying more frequently than they need to. We are underselling ourselves and it doesn't help public confidence."

He added: "I don't wish to give the impression that everything is hunky dory or that we don't need more oncologists or radiotherapy machines. But that is a different argument."

His view was backed yesterday by Dr Peter Boyle, the director of epidemiology and biostatistics at the European Institute of Oncology in Milan. Dr Boyle said international comparisons could not be relied on because the disease might be more advanced at diagnosis in some countries than in others."There may well be differences [in survival] but we can't say whether they are due to treatment, diagnosis or something else. I don't think anyone knows the true position," he said.

Figures produced at the Eli Lilley conference of oncologists showed that Germany spends six times as much per head of population on cancer drugs as the UK - and many other countries exceed British spending on drugs. Dr Boyle said global comparisons of this kind were meaningless: "If the money was available Britain could spend 10 times as much as Germany on cancer drugs. Is spending money the key thing or is it spending it appropriately? We need to know the outcome of higher spending for individual patients, but that is difficult to assess."

The best cancer units in Britain provided care that was the equal of any in the world but the standard varied widely. There were also regional differences in death rates. Dr Boyle said the best hope lay in the Calman- Hine proposals for spreading "best practice" by concentrating cancer care in specialist units linked to district hospitals. "Calman-Hine was a huge breakthrough that put the patient, not the organisation, first. It has been very successfully implemented in Birmingham and Yorkshire. It should ultimately lead to a better deal for patients," he said.

The Secretary of State for Health, Alan Milburn, pledged last month to focus on improving cancer services, and announced an investment of a further pounds 80m. He has set a target of saving 60,000 extra lives from cancer by 2010.