Stay Abreast Of Cancer

Itís October - and breast cancer is in the spotlight again. But for once there is good news for Guernsey. Research has revealed that the island's screening policies are helping to save the lives of older women. But there is no room for complacency, as Catherine Kalamis explains

GUERNSEY women have an edge over their UK counterparts when it comes to breast cancer.

They are offered more frequent screening and for longer. As a result, more lives are being saved in the over-65s. But although more women fall into the screening 'net', not all take advantage of the service. Now, because of new research, they are being actively encouraged to do so. The first results of the island's decision, in the mid-90s, to offer free mammograms to women aged between 50 and 74 were unveiled at an international breast cancer conference in Nottingham. It gave the 900-strong audience an opportunity to hear that the Guernsey system offers life-saving benefits. And it was pertinent - in April next year, the UK will raise the maximum age that women can have free screening on the NHS from 64 to 69. This will be an improvement for older women there, but still not as good as the Guernsey system. The island's policy means that 5,000 women aged over 66 -that's 9% of the population -are eligible to receive regular free screening. They would have slipped through the net had they lived in the UK. Breast surgeon Roger Allsopp, who attended the conference to hear the island's pathologist, Dr Catherine Chinyama, deliver the findings, said that the screening service put Guernsey 10 years ahead of the UK.

The research covers the incidence of breast cancer in Guernsey between 1995 and 2002 - a total of 334 cases -and divides the results into cancers discovered through screening and those found as a result of women reporting lumps or other symptoms. A total of 44% of all the cancers surveyed were found in women over 66 - and 35% of those were detected as a result of routine screening, representing 51 women. It is this group which could owe their lives to the screening programme. A big plus for screening is cancers picked up on mammograms tend to be smaller, with a better outcome and survival rate. 'The overall survival of the older age group is better than the figures for Great Britain,' said Mr Allsopp. There were, however, a further 95 women over the age of 66 who discovered symptoms themselves and reported them to the doctor.

It is this combined evidence that creates a good case for screening older women and which will provide useful material for other jurisdictions. The research paper, Breast Cancer in Older Women: the Guernsey Experience, says: 'Most breast units in developed countries now invite women for breast cancer screening up to the age of 69 or 70 years. Very few units like Guernsey invite women over 70 for screening." Dr Chinyama told the conference that there was a high prevalence of screen-detected cancers in the 66-70 and 71-75 age groups, but the number of symptomatic cancers notably increased when screening stopped In the 76-80 and 81-90 groups. 'Yes, we are getting some cancers hi screening, but often older women, notably the over-75s, tend to leave it to chance. My message is: "don't stay at home - come for screening". If you can detect it early, it is treatable.'

* Breast Cancer In Older Women: the Guernsey Experience was presented to the International Breast Cancer Conference in Nottingham. Authors: Catherine Chinyama, Louise Gaunt, Jonathan Rice, Peter Gome and Roger Allsopp.

Treating Older Women

The Guernsey research has raised the issue of the consequence of screening much older women - in their 70s, 80s and 90s. If cancer is found, decisions have to be made about treatment. Surgery for breast cancer can be major. The Guernsey research revealed that one woman of 89 had undergone it. Mr Allsopp pointed out that research in the US had found that women who contracted breast cancer at 75 could still live up to 92.

'We now have to assume that people will live well into their 90s. People are living longer.' But as they now age better, their chronological age is not always the best guide as to how suitable they would be for major surgery. Some people in their 70s have the lifestyle - and physique normally associated with those in their 50&.

Mr Allsopp said that determining a person's 'age' was becoming more subjective for doctors and was not always linked to the years they had lived 'It is how people look, how they feel, what they are doing and [physiological markers such as their blood pressure level. But the important thing is not to be ageist and this is something doctors are becoming increasingly aware of.

The Guernsey research found that 146 women over 66 had treatment for breast cancer and 63 of them were over 76. A total of 19 over 76 had a mastectomy, or breast removal, which is a major operation. 'If tumours are found by screening they tend to do extremely well.'

When regular breast screening was introduced into the island in the mid-1990s, the powers that be looked at different health systems.

In the UK screening was being offered to women from the age of 60 to 64. But in sweden, it was provided for women up to 74.

Guernsey chose to adopt this route. 'We could see what was happening there. And we looked at the evidence,' said Mr Allsopp.

Because of Guernsey's size, it is not that much more expensive to offer screening to older women - unlike the UK, where the sheer volume would be an economic burden. Guernsey women are invited every two years from the ages of 50 to 74 and after that, they can decide whether to continue or not. If they choose to stay in the screening programme, they will continue to receive regular invitations Research suggests that 98% of women who are found to have small cancers - under 1.5cm - are alive and well after years.

'By screening we are picking up smaller tumours and putting more women into that group’

Why not younger women?

Mr Allsopp said pilot studies to look at this option were under way in the UK.

'If they can show a benefit, then it could be considered. But it has to show a benefit, as there are a lot of implications. One has to keep an open mind about women between the ages of 40 and 50. But you have to weigh up the economic costs and benefits and the adverse effects screening this age group might cause, such as unnecessary surgery. It is taxing people working in this field - should we screen them or not?' One of the issues is that some breast cancers would have been picked up at 50 anyway and finding them earlier would have made no difference to the outcome, but would have caused distress earlier. But there might be another group of women for whom earlier screening could be lifesaving and this is being studied. Although breast cancer does occur in younger women, the incidence increases with age. At 50, a woman has a 1 in 50 chance of contracting the disease, but it's a lot less for a woman in her 30s or 40s. There are difficulties in screening younger women. Breast tissue is denser, which can make it more difficult to pick up tumours.

(Reproduced courtesy Guernsey Press and Star)

Article dated 03 October 2004

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