Stop teaching breast self-examination, say Canadian experts

Newsdesk Stop teaching breast self-examination, say Canadian experts The Canadian Task Force on Preventive Health Care recommends that women aged 40–69 should not be routinely taught breast selfexamination (BSE). “Women need to remain aware of their breasts and immediately report any changes to their physician”, stresses Nancy Baxter, author of the task force’s report (CMAJ 2001; 164: 1837–46), “but we don’t seem to be able to teach them to do that any better than they are already doing on their own”. Michael Baum (University College Medical School, London, UK) welcomes the Canadian advice. “The bottom line of any screening modality is that it should save lives. I am not aware of any evidence that BSE does this, but I am aware of the harm it does – women who do BSE have twice as many unnecessary biopsies as women who don’t. BSE is bad advice and we should stop giving it.” The task force reviewed the literature on screening for breast cancer by BSE. They found seven adequately designed studies, including two randomised and one quasirandomised trial. The main outcome analysed was prevention of death from breast cancer. “We found no evidence of effectiveness”, explains Baxter, “but we did find evidence of harm, mainly increased benign biopsy rates, physician visits, and anxiety”. These results led to the recommendation that BSE should no longer be taught. Indraneel Mittra (Tata Memorial Hospital, Mumbai, India) does not agree that the conclusions from the analysis should be used as a formal recommendation against BSE. “Unlike mammography, which is an intervention, BSE is an advice, which women may not always take. This does not mean we should stop giving it”, he says, pointing out that there is evidence from a Finnish study, included in the Canadian analysis, that when women do comply they derive a benefit from BSE. However, Baxter estimates that fewer than 50% of women in North America do BSE regularly. Anthony Miller (University of Toronto, Canada) and Robert Smith (American Cancer Society) raise THE LANCET Oncology Vol 2 August 2001

A lesson on breast self-examination

doubts about the analysis itself, quoting short follow-up in one randomised trial and incomplete analysis in the other. “BSE should still

be recommended to women, provided their physician refers them on appropriately”, argues Miller. “Women need the protection of BSE, particularly if routine screening by clinical breast examination or mammography is not done yearly.” Baum estimates that fewer than 1% of breast cancers are found during routine BSE. Even so, says Smith, “the fact that many of the women who detect their own breast cancer do so on occasions other than the day they do BSE does not diminish its value, since the heightened awareness was probably achieved by doing BSE.” Jane Bradbury

Bureaucracy is stifling cancer care in Europe The Cancer Research Campaign (CRC), a UK cancer charity, claims that European cancer patients are not receiving the latest treatments because of stifling bureaucracy. “Many people with cancer in EU countries are facing unacceptable delays in gaining access to new treatments as a direct result of lengthy bureaucratic reimbursement procedures”, said CRC Director, Gordon McVie at the Third Global Conference for Cancer Organisations (Brighton, UK, 24–27 June), hosted by the CRC, the Imperial Cancer Research Fund and the International Union Against Cancer. Bureaucratic delays are attributed mainly to government health services, including the National Health Service in Britain, with the Campaign for Effective and Rational Treatment (CERT) claiming that Britain lags behind most of Europe in the provision of new cancer drugs to patients. According to David Turner, CERT Director, “We are very concerned about the delays at the National Institute of Clinical Excellence (NICE) in evaluating new technologies in the UK”. Despite advice from the UK Government that health authorities should support new technologies and not wait for NICE approval, health authorities are

not proceeding with new cancer treatments. On the 14th July 2001, the Department of Health announced further delays in evaluating cancer treatments by NICE. A key demand from the conference was for European Governments to address the issue of delays to anticancer drug approval and for European anticancer organisations to put pressure on governments to accelerate the present procedures. CRC figures list Greece, Portugal, Belgium, and France as experiencing some of the greatest delays in approval to prescription of new drugs, in contrast to an average wait of 3 months in Sweden. Each EU member state has separate pricing and reimbursement systems, with some countries having a succession of government departments which must review new drugs. McVie believes that the current delays of up to 4 years between European approval and UK authority approval for reimbursement for drugs such as docetaxel for breast cancer are unacceptable. While the review processes for such drugs can take years, “the life expectancy of some of those cancer patients who could benefit from them can be a couple of months”, says McVie. Georgina Kenyon

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