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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
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
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
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