UPDATE - Issue 06 - September 2000
Will the Government's target for fewer cancer deaths be met?
- Our analysis gives grounds for optimism
In July 1999 the Government set a target to reduce mortality from cancer in people under 75 in England by at least 20% by the year 2010. A recent British Medical Journal article asked the question 'Can the Government's target be met without special actions? Would relying on the year on year improvements which have occurred over the past 20 years or so be sufficient?' The answer, derived from an analysis of statistics on all cancers, diagnosed in the period 1981 to 1990 is No. That would only achieve about one quarter of the Government's target.
Variations between cancers
Overall the study showed that survival rates had improved by 3.3% every five years. Breast cancer showed the largest reduction numerically. Melanoma and testicular cancer exhibit the largest in percentage terms, since these two have now become largely curable diseases. Prostate cancer, historically, showed one of the smallest, improvements, a paltry 1%. However, we believe that this disappointing result is no guide to the future where the outlook is much more rosy.
Conservative analysis
We have been conservative in our analysis in only looking at treatments and technologies which are available today. On top of that one might anticipate some impact by 2010 from treatments currently in the research phase; drugs which slow a tumour's growth by cutting off its blood supply; drugs which harness the body's immune system more effectively; drugs tailored from knowledge of prostate cancer specific genes and so on. There may even be some impact from the increased number of consultants promised by the Government although since they take about seven years to train it will not be large by 2010.
Why will things improve?
The study reported in the BMJ looked back at data from 1981 to 1985 and compared that with the next five years data. So the results reported relate to a period effectively ten years ago. Factors introduced since that time should, therefore, have a positive impact on the situation. So what are these?
- Raising awareness amongst men in the 'at risk' age group.
One of Prostate Research Campaign UK's aims is to make men aware that, if caught in time, prostate cancer can be cured. - Widespread use of available diagnostic tools, notably the PSA
test.
PSA testing became widely available from 1986 and was enthusiastically used in the USA. In the UK, however, its adoption has been very slow and its impact cannot show up in the BMJ article figures. Indeed, as recently as 1997 the Health Technology Assessment panel concluded that 'PSA testing should be limited to men with clinical evidence of prostate cancer who have a life expectancy of at least 10 years'. Now, at last, one finds the majority of GPs using the test when there is a suspicion of cancer and of course counselling the patient about the treatments and possible side effects. This is saving lives. - The impact of modern treatment techniques.
These include radical prostatectomy, of which the first was carried out in this country in1987; radiotherapy, which, though available since the 1970s was little used to treat prostate cancer before the PSA era began in the early 1990s; brachytherapy which has been available here in just a few centres for about two years.and conformal radiotherapy first described in 1995 but still not widely available in the UK, even today. - Improvements in hormone drug therapies.
Anti-androgens have had an impact both in slowing down the growth of the disease and reducing tumour size to make other treatments more likely to succeed. One of the most frequently prescribed, has only been licensed for use for about four years. - The ability to afford and use expensive scanning equipment to
assist diagnosis.
Computer Aided Tomography became available in the early 1990s whilst Magnetic Image Resonance (MRI) scanning was introduced about five years later.
Screening
This Government, like its predecessors, adopts a negative attitude to screening. If the Department of Health were to accept that the findings of studies carried out in North America and now in Austria, are more likely to be applicable in the UK than not, then we might, as a society, decide that the cost of a national screening programme was justified by the significant decrease in deaths which would occur.
Conclusions
We conclude from the evidence that there are extremely strong grounds for believing that the five year relative survival rate for prostate cancer will rise substantially over the coming decade from the 1986 to 1990 figure of 41.4%. Whether that will be sufficient to meet the Government's target or, indeed, to beat it by a substantial margin we cannot say. What is certain is that ignoring the screening option will reduce the likelihood considerably.