How to kill breast cancer

There is persuasive new evidence that breast cancer can be beaten. Although it kills more women than any other malignancy, deaths from breast cancer are falling, down in 1993 by 10 per cent in England and Wales, compared with 1985-89.

Why should this be? Much of the answer is because of earlier diagnosis and more effective treatment. As breast cancers grow, so does their capacity to spread and kill. Picking up invasive cancers by mammographic screening, now on offer to all women aged 50-64, detects cancers when they are smaller and curable. It is too early to attribute changes in Britain to screening but within two to three years a further drop in mortality will become apparent as a result of the UK national programme.

More women are being diagnosed with small breast cancers because they are aware that early diagnosis can be life-saving and that mastectomy can usually be avoided. Treatment has improved, because those at risk of recurrence are now given therapy in the form of hormone treatment or chemotherapy, or a combination. This saves thousands of lives worldwide every year.

But there are still too many women dying unnecessarily. Screening is not reaching enough women at risk. Almost 50 per of breast cancer cases are over 65 when diagnosed and yet women of this age are not called routinely for screening mammography. Extending the age limit to 80 could save 1,500 lives per year in Britain.

Another approach is to identify those at risk. The cloning of the breast cancer susceptibility genes, BRCA-1 and BRCA-22, will enable us to detect women who have inherited this mutation and who have an 80 per cent lifetime chance of developing the disease. We must then tackle the threat.

Prevention is better than surgery. Changes in lifestyle - exercise, dietary modification, food additives and hormonal modifications - all need to be tested in a rigorous scientific manner. We know from results of using tamoxifen therapy that this reduces the recurrence of cancer and also reduces by 40 per cent the probability of a cancer developing in the other breast.

One of the clearest messages about treatment of breast cancer is that a team approach involving surgeon, pathologist, oncologist, radiologist and psychiatrist is fundamental. This is the situation that exists in specialised centres and there is mounting evidence that their patients have better survival. Lives should not be endangered by lack of expert management of this potentially curable disease.

The writer is Consultant Surgeon, Imperial Cancer Research Fund Clinical Oncology Unit, Guy's Hospital, London.