Britain has low mastectomy rate

Screening helps detect tumours early

Britain has one of the lowest breast removal surgery rates in the world for patients with breast cancer, a survey shows.

Encouragingly, this may be due to early cancer detection through breast screening, say experts.

Delegates attending the European Breast Cancer Conference in Hamburg were told of wide variations in mastectomy rates across the world.

Mastectomy rates were highest in central and eastern Europe.

Among the 10 countries studied, Britain's rate was second lowest at 31%, ahead of France at 28%.

Poland led the field at 98%, followed by Spain (66%), USA (56%), The Netherlands (48%), Switzerland (47%), Germany (43%), Italy (41% ) and Belgium (37%).

The figures were obtained from an analysis of surgical techniques used in an international trial involving 4,700 women with early breast cancer in 37 countries.

A detailed analysis was carried out for the 10 countries that had contributed a minimum of 150 patients drawn from several cancer centres.

All the patients were post menopausal.

Early detection is strictly related to screening programmes and in countries with no screening programmes the cancer is likely to be more advanced on average at diagnosis

Professor Jacek Jassem, cancer specialist

Overall, more than half the patients underwent a mastectomy, while the rest had some form of breast conserving surgery, the conference was told.

Breast conserving surgery involves the partial removal of the breast, followed by radiotherapy.

Professor Jacek Jassem, who carried out the analysis, said he believed cultural reasons influenced the treatment programmes.

This could include access to radiotherapy and doctors' and patients' attitudes towards treatment options.

Professor Jassem, a cancer specialist from the University of Gdansk, said good screening programmes lead to early detection of tumours, which means conservation surgery is more likely.

He said he was surprised to see such high mastectomy rates since conservation surgery was now widely accepted as a viable alternative to mastectomy.

Countries 'shamed'

He said: "Early detection is strictly related to screening programmes and in countries with no screening programmes the cancer is likely to be more advanced on average at diagnosis.

"We can't take tradition and surgeons' and patients' attitudes into account in the analysis but this may be another factor.

"Finally, in some countries, access to radiotherapy may be an issue."

He told BBC News Online that the high rates were "shaming" for the countries involved.

He said: "I think they will have to change their approach.

"I am planning to get wide publicity for these findings so that women are aware of their options and have an equal chance of having their breasts saved.

"They should lobby to have them saved."

In the UK in 2002-03, the number of breast cancers detected by screening went up by more than 13% from the previous year, Department of Health figures reveal.

Detection rates have been steadily increasing for the last five years.

It is believed that the increase is in large part due to the introduction of more advanced screening technology, called two-view mammography.

This involves taking two x-ray views of each breast at the screening appointment - one from above and one into the armpit diagonally across the breast.

Research has shown that this technique can increase the detection rate of small cancers by 42%.

In December 2003, 86% of local screening services were doing two-view mammographies.