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Friday, 17 March, 2000, 17:19 GMT
The politics of cancer
The government's approach to cancer is a key part of their reforms of the health service - and one of the most important ways its overall success will be measured.
Well over 150,000 people in the UK die every year from some form of cancer.
Yet cutting this death toll substantially - as the present government has pledged - will take many more millions per year - as well as an enormous political will to tackle some of cancer's causes.Once someone learns they have cancer, they and their relatives assume that in a highly developed country such as the UK, the best treatments will be available.
However, this is not necessarily the case. As the latest drugs and machinery become more and more expensive, it becomes increasingly difficult for health authorities to fund them.
The prime example of this is a class of cancer drug called taxenes, of which the best known is Taxol.
Taxol, when combined with another drug, has been clearly shown to be the best treatment plan for many cases of ovarian cancer - a type of cancer which kills several thousand women a year in the UK.
However, it costs several thousand pounds a year to place a patient on this drug, and while some women have been able to get it on the NHS, others have not, depending on where they live.
This has been described as "postcode prescribing", a lottery which ministers have pledged to stamp out.
Bladder cancer expert Dr Nick James says that some specialists do not tell their patients about the existence of new, expensive drugs.
"Some doctors find it easier because they know these drugs won't be available on the NHS. But I think patients should be given the information."
Ministers are hopeful that a new body, the National Institute for Clinical Excellence (NICE) will help address this.
It is assessing all the evidence about treatments to work out which ones are most cost-effective.
If a drug is very expensive, but offers only tiny improvements on a much cheaper version, then it may not be recommended, but if the benefits are significant, then it will.
Health ministers are expected to abide by the recommendations of NICE.
But it is not just drugs which the NHS lacks - much of the equipment used to diagnose cancer or deliver radiotherapy is becoming out of date.
This inevitably means that in some patients, cancers will be missed, and that others will receive a higher or less effective dose of radiation than with modern machines.
The government has also moved to remedy this, diverting well over £100m of lottery money to upgrade scanners and radiotherapy machines.
However, in terms of death rates from cancer, the UK lags behind many of our European neighbours, despite being the location for many clinical trials of the latest experimental drugs.
Some of these deaths, say campaigners, can be put down to lifestyle factors, but others, they say, are due to longer waits for cancer surgery, older equipment and the use of cheaper drugs.
A case in which a pensioner's oesophageal cancer became inoperable because her surgery was repeatedly postponed highlighted how cancer patients could be affected by other pressures on the health service.
In the wake of this, Prime Minister Tony Blair said he intended to pump money into the NHS to bring UK spending up to the European average - but stopped short of making it an official pledge.
The government's public health strategy, "Our Healthier Nation", set a target to reduce cancer deaths in the under 65s by a fifth by the year 2010.
This would save approximately 6,000 lives a year.
One of the key elements of this drive was to reduce the level of smoking - lung cancer is still the biggest killing cancer in this country, and smoking is linked to several other cancers.
However, it is becoming clear that other factors, such as a poor diet could also be culpable in cancers such as bowel - certainly diets rich in fruit and vegetables appear to help prevent some cancers.
Improving the nation's diet is a major challenge for the government.
But as previously untreatable cancers now begin to respond to new drugs, the cost of fighting the disease once it develops is expected to rise for the foreseeable future.
And increasingly well-informed patients will not accept anything less than the latest breakthroughs.
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