Why is the UK lagging on cancer?

By Clare Murphy
BBC News health reporter

Your chances of surviving cancer in the UK remain below the European average.

And only in former eastern bloc states are you more likely to die if you develop lung, breast, prostate and colorectal cancer. Why?

Not enough of these or them?

The good news is that, all in all in the UK, cancer survival rates are improving. But why they still lag behind those of our European neighbours is what's at issue - and it is not an easy question to answer.

More money than ever before is going into a UK cancer strategy which pledges more specialist staff and equipment, and places strict limits on how long you must wait for referral and treatment.

For one, the full effect of these measures, introduced in 2000, is unlikely to have come through in these latest figures.

There is also some debate about whether countries collate data in the same way, and so whether like is being compared with like.

See the main results

The UK, it has been tentatively suggested, is perhaps more rigorous than some of its European counterparts when it comes to collecting these statistics.

But despite the caveats, the report does raises questions about the speed and quality of care for cancer patients in the UK, even if the answers are hard to pin down.

First things first

The key to improving cancer survival rates is early diagnosis. One way to do this is through nationwide screening, already done for breast and cervical cancer, and in the process of being rolled out for colorectal cancer.

We're in second gear at present, and we need to keep pushing to go into third Prof Richard Sullivan Cancer Research UK

There is little to suggest the UK's screening programme is inferior to those of other European countries in terms of the range of cancers covered or the quality of care.

While screening does seem an obvious step in tackling the disease, in some cases it is of limited value, experts say. For lung cancers, there is no evidence screening improves life expectancy for those found to have tumours, and for prostate cancer, the jury is still out.

The first port of call for cancer detection really needs to be the patient himself - and some argue it may be him who is the real hurdle.

Cultural and gender issues have been put forward as among the possible reasons why people do not always go to the doctor when they first spot symptoms.

The famous British "stiff upper lip" or just sheer embarrassment is what may for instance prevent the older men who are most at risk of bowel cancer booking an appointment with their GP when they first notice symptoms like unusual rectal bleeding.

But even if this reluctance "to present" is an issue - and some argue there is no evidence to suggest it is - once they have made that appointment, the NHS does appear to be kicking into action.

GPs - who, perhaps contrary to popular belief, do not see that many cancer patients in the course of their career - are getting much better at spotting the symptoms and dealing with them appropriately.

If anything, the tendency is now for GPs to over-refer to specialists, rather than the other way around, and many suspected cancer cases are being seen by a consultant within two weeks.

What then?

But there are issues which then arise with the quality and speed of treatment offered, according to Professor Richard Sullivan of Cancer Research UK, who identifies one of the key problems as a shortage of skilled surgeons.

Breast screening is offered routinely on the NHS

While in other European countries, there are surgeons who specialise in cancer operations, there is not the same tradition of this in the UK - although this is starting to change, notably with an increase in breast cancer specialists.

The other problem he notes relates to radiotherapy - both in terms of trained staff and the availability of equipment.

France for instance, which has some of the best cancer survival rates in Europe, has 336 machines compared to the UK's 279 - 20% more for the same population, and the staff to match.

And while targets for treatment are being met, they do not always give the true picture.

There may be a maximum 62 day wait from urgent GP referral to treatment, but this simply means the start of treatment.

There are instances where people are waiting as long as 16 weeks for post-operative radiotherapy, a key part of their treatment which can maximise their chances of being cured.

Drug debate

There is despair among some cancer specialists that the public gets so agitated about the provision of new cancer drugs while radiotherapy frequently gets short shrift.

Access to drugs may be less of an issue than we imagine

It is true, that for instance in France, new cancer drugs are automatically paid for out of a central budget so that local hospitals do not have to choose between providing one medication and another - a system which leads to the so-called postcode lottery here.

But whether this has much effect on survival rates taken as a whole is unlikely, says Dr Mark Matfield of the Association for International Cancer Research.

"If we take Herceptin as the most obvious example, it only works on 25% of breast cancers, which is 11,000 cases a year - out of a total of 285,000 cancers diagnosed each year in the UK.

"The other new, expensive treatments work on less common cancers. So, there might be some, limited effect as far as breast cancer is concerned but it is unlikely to be a noticeable effect of any other cancers."

The consensus appears to be that the UK should not feel too down about its cancer prognosis.

Change may just be happening at a slower pace than was initially anticipated.

"We're in second gear at present," says Cancer Research's Professor Sullivan.

"And we need to keep pushing to go into third."

5-YEAR SURVIVAL RATES FOR ALL CANCERS

Countries grouped then ordered by total national expenditure on health

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