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Breast cancer: History in the UK

The early 1990s saw the start of some significant reductions in death rates attributable directly to breast cancer.  Since then, it has been established that two almost coincident Past Longevity Catalysts were chiefly responsible.  These are examined in more detail below using the general Mortality Improvement Framework.

 

 

 

 

1. BIG BANG - BREAST SCREENING

NHS breast screening is launched in England & Wales

1988

2. OBSERVABLE CHANGES

Increase in proportions diagnosed with breast cancer at early stages. Five year survival rates drop from 90% when diagnosed at stage I to only 13% when diagnosed at stage 4 (Source: Department of Health and Cancer Research UK)

1990s

3. IMPACT ON HEALTH OUTCOMES

Increased survival rates owing to both (a) early diagnosis - see table below - and (b) treatment with Tamoxifen

1990s and 2000s

4. IMPACT ON DEATH RATES

See below for breast cancer specific improvement rates

1990s and 2000s

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1. BIG BANG - TAMOXIFEN

Increased clinical acceptance of the use of tamoxifen to treat women with breast cancer

mid 1980s

2. OBSERVABLE CHANGES

Rapid increase in use amongst women with breast cancer. By 1990, in the Thames regions, over 90% of women over age 50 and over 50% of women under age 50 received tamoxifen for breast cancer treatment (Blanks at al, BMJ 2000)

1990

3. IMPACT ON HEALTH OUTCOMES

Increased survival rates owing to both (a) early diagnosis - see table below - and (b) treatment with Tamoxifen

1990s and 2000s

4. IMPACT ON DEATH RATES

See below for breast cancer specific improvement rates

1990s and 2000s

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Improvements in female breast cancer mortality rates E&W 

Hotter colours illustrate​ greater improvements from 1988 onwards

Strong improvements continue to be observed in the recent past 

The study by Blanks et al (BMJ 2000) attempted to disaggregate the drivers for the decline in breast cancermortality over the 1990s.  It suggests that changes in treatment accounted for around 70% whilst the remaining 30% were due to the introduction of screening.  

Stage of Diagnosis

Five year survival rate (%)

Stage I

90

Stage II

70

Stage III

50

Stage IV

13

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The above chart illustrates that earlier dagnosis has a significant impact on breast cancer survival rates

 

Data sourced from Department of Health 2010b; Cancer Research UK 2011c

Certain cohorts of lives were too old for the introduction of screening and / or use of tamoxifen to have an impact

Source: PIC calculations based upon ONS and causal data