How Much Breast Cancer Treatment is Necessary
A recent BBC News story reports on a growing controversy involving breast cancer care guidelines issued by Great Britain’s National Institute for Health and Clinical Excellence (NICE), and disagreement over those guidelines from the British medical community.
So what, you say? What does that have to do with me? Well, it’s food for thought, especially if you’re a survivor out of active treatment for breast cancer and watching the disease-free years tick by.
NICE is an independent organization that functions much like our American Cancer Society (albeit across all health issues, not just cancer). The guidelines that are stirring up a hornet’s nest recommend no more than 2-3 years of follow-up care for breast cancer survivors, noting that longer care is “ineffective and unwarranted.” NICE also argues that the “yield is low” for mammography–i.e., mammograms are of questionable benefit.
Now, I understand that some evidence supports this lingering belief that mammograms do nothing to change the death rate from breast cancer. But I also know way too many women who’d be dead from cancer, except for the fact a mammogram caught it early. I don’t buy the research on this one. You know what they say about data: torture it till it says what you want it to.
Speaking of data, did you know that 70% of both recurrences and new breast cancers appear AFTER the first 3 years following treatment? That’s right; if you have a recurrence in the same breast (or a metastasis), or a new cancer in the other breast, more than likely it’ll happen later in your life.
Which is why surgeon Michael Dixon of Edinburgh disputes the NICE guidelines when he writes in the British Medical Journal that after 2 years of regular checkups, mammograms should continue for at least 10 years. "Mammography is a very effective way to detect treatable local disease, and fully funded mammographic surveillance programmes specifically for patients with breast cancer are urgently needed," write Dixon and colleague David Montgomery in their editorial in the BMJ. Note the emphasis on “fully funded”–Britain has a government-funded health care system, so a statement like this is more controversial than it would be here in America, where it’s usually privately funded health insurance–not tax dollars–that picks up the bill.
Meanwhile, Anna Wood of the UK’s Breast Cancer Care, a 30-year-old charitable organization, says in a follow-up to the BMJ editorial, “More needs to be done to meet the psychological and emotional needs of patients to help them cope with living with cancer, with greater information about where to go with clinical concerns once the follow-up period has ended.” Amen to that. Six years past treatment, I definitely need help figuring out where to take my concerns about growing aches, pains, and hot flashes.
And Catherine Foot, head of policy at Cancer Research UK (great Britain’s leading cancer charity), says in the aforementioned BBC article, "We know that almost two-thirds of women with breast cancer now survive for at least 20 years. So it is vital for all patients to have access to high quality follow-up services that are tailored to the individual's needs for many years after treatment."
Meanwhile, NICE has responded by issuing a statement that revised guidelines will be developed by February 2009. Let’s hope that these new guidelines include mammograms funded well beyond the 3-year post-treatment window; as well as acknowledgement of the fact that surviving breast cancer is a lifelong journey. The focus may change from active treatment to “watchful waiting,” but once a woman has breast cancer, it remains a dominant health concern for the rest of her life.
Published On: January 27, 2008