Leading article: Not so far behind Europe, after all

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Today's report on breast cancer is good news for women and good news for the UK. Over the past 20 years, deaths from the disease have fallen more rapidly in this country than anywhere in Europe (save Iceland), with a 35 per cent decline in the mortality rate. Earlier diagnosis, advances in surgery, better drug treatment and increased access to specialists are the keys to improved survival. But, as the UK started with the highest breast cancer death rate in the world in the late 1980s, celebrations should be tempered by remembrance of the thousands of women who might have survived if they had lived elsewhere in Europe.

Britain's death rate has now almost fallen to the European average. At 28.1 deaths per 100,000 women, it is already below that of the Netherlands (30.1) and is fast catching that of France (25.6). Philippe Autier, the head of the International Agency for Research on Cancer based in Lyon, who led the study, said he believed England was likely to continue reducing its death rate and could overtake France, which has devoted huge resources to combating breast cancer.

Britain's annual 2 per cent fall in the death rate easily outstrips that in France (1.4 per cent). Yet France has one of the highest rates of breast screening in the world, has the highest spending on cancer drugs per person in Europe, devotes much effort to ensuring doctors follow guidelines, and is at the forefront of the introduction of costly new treatments. As Dr Autier said, there is an urgent need for the French authorities to examine what is going wrong.

Today's figures go some way to answering the puzzle of why the UK's reputation on breast cancer is so poor when its performance has been good. The answer may be that, while deaths are accurately recorded, cancers are less so because of shortcomings in the operation of the cancer registries. This creates the impression of a worse death rate than is actually the case.

The report also suggests that ageism still blights care in the UK and across Europe. In every country the death rate declined more steeply in women under 50 (by 42 per cent in England) than in women over 70 (by 22 per cent). Partly this may be because younger women respond better to treatment even though their cancers tend to be more aggressive. But it is also because women over 70 do not generate the same concern or receive the same service as their younger sisters. "Better treatment for older women" should become the new breast cancer slogan for the coming decades.

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