Compared to Screening, Improved Treatments and Health Systems cause a decline in Breast Cancer Death Rates

Over the last few years, death rates due to Breast cancer have declined in Europe, although, researchers from France, Norway, and the UK believe that improved treatment and health systems have led to this change rather than breast cancer screening.

In an article published in the BMJ (British Medical Journal), the authors wrote that: “..breast cancer screening has not played a direct part in the reductions of breast cancer mortality in recent years.”

Over the last few years, most developed nations have witnessed a decrease in the breast cancer mortality rates. According to the authors, it is very hard to establish what fraction of that decrease over two decades of mammography screening can be attributed to early detection or better management.

Evidence confirms that cervical cancer death rates have decreased due to screening programs. Between 1965 and 1980, Nordic countries experienced earlier reductions in cervical cancer death rates because they incorporated screening programs before their European counterparts.

Researchers decided to employ a similar approach in this study. Breast cancer mortality patterns within three pairs of countries were compared:

• Northern Ireland vs. The Republic of Ireland
• The Netherlands vs. Belgium (and Flanders)
• Sweden vs. Norway

Countries that had incorporated early breast cancer screening programs were expected to demonstrate decreased death rates. The countries that were paired had similarities amongst people, breast cancer risk factors, and levels of healthcare services. However, there was one country within each pair that had commenced early mammography screening compared to the other- this was the only real difference.

The authors explored the WHO mortality database to gather data on causes of death between1980 and 2006. Information on risk factors, death, mammography screening, and cancer treatments was further collected by authors.

From 1989 to 2006, the three pairs of countries demonstrated the following decreases in breast cancer rates:

• 29% in Northern Ireland, compared to 26% in the Republic of Ireland
• 25% in the Netherlands, compared to 20% in Belgium (25% in Flanders)
• 16% in Sweden compared to 23% in Norway

The authors explained that there was no significant difference in death rates in the pairs of countries despite implementing mammography screenings many years apart. The researchers also emphasized that the greatest decreases were observed in females between the ages of 40 to 49, regardless of whether they had the accessibility to screening.

The authors concluded: “The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality. Improvements in treatment and in the efficiency of healthcare systems efficiency may be more plausible explanations. ”

Earlier today, the United Kingdom launched the first licensed Hepatitis C medication known as Victrelis (boceprevir). Compared to current therapy, Victrelis is said to aid in virus clearance in thrice the number of patients who did not respond properly to prior treatment, and twice the number of treatment naïve patients.

Chronic hepatitis C (CHC) adult patients with genotype 1 infection are prescribed Victrelis. It has been approved as an adjunct to standard therapy comprising peginterferon alfa and ribavirin. Patients with severe liver disease who do not respond to previous therapy, or are treatment naïve are usually prescribed Victrelis.

According to reports form clinical trials:

• SVR (sustained virologic response, i.e., virus clearance) was achieved by 2.8 the number of patients receiving boceprevir as an adjunct to standard therapy compared to those who were on just standard therapy.

• SVR was achieved by 1.7 the number of treatment naïve patients receiving boceprevir as an adjunct to standard therapy compared to those who were on just standard therapy.

Because of a critical unmet public-health need, Boceprevir received accelerated approval after assessments by the EMA (European Medicines Agency).

Consultant Hepatologist of St Mary’s & Hammersmith Hospitals, Dr Ashley Brown , said: “Over the last 10 years there has been little development in the treatment of HCV and a significant proportion of patients fail to respond to current standard of care. ‘Victrelis’ is the first licensed drug to directly target the virus. It offers improved outcomes for genotype 1 patients and new hope for those in whom previous treatment ha