A number of papers reported on a study of breast cancer survival rates in several countries, undertaken by the London School for Hygiene and Tropical Medicine, today. I haven't really looked into that study, mostly because the findings, as reported in the papers, don't sound all that dramatic or surprising. However, presumably because it considered this study not quite dramatic enough, the Daily Mail decided to add reportage of a second study to its story. In the article, Jenny Hope (who else) claimed that British oncologists are guilty of scandalous ageism, because said study has found that the majority of breast cancer patients over the age of 70 aren't offered chemotherapy after surgery. This is, apparently, particularly outrageous because chemotherapy improves the effectiveness of Herceptin, and because a significant part of these women weren't tested for HER2 before it was decided not to offer them chemotherapy.
I have a list of issues with this report roughly as long as my arm, but let's start with the fact that the study was first published more than a month ago. Not usually likely to miss an opportunity for sensationalism, I'm wondering why they're only catching on now? But anyway, that has little to do with the actual content of the report; my other complaints do.
As the Mail clearly states, this study was funded by Roche. You know, that Swiss pharmaceutical giant that produces, among other things, Herceptin and Xeloda, a chemotherapy drug often used in combination with Herceptin. I would've been a bit surprised if a study sponsored by a drug's manufacturer had concluded that more than enough women are being prescribed it... Call me a cynic.
It took a fair bit of trial and error searching, but I've found the original study - well, I found the abstract, because I'm not willing to pay US$32 to read the whole thing, and the day I figure out how to log into PubMed via my uni will be the day I quit my job and devote my life to reading everything written in the scientific literature ever - and I couldn't help but notice that from the first section, the background information, it seems like this study was not so much aimed at finding new information as at making a pre-conceived point:
"As few older women with breast cancer receive adjuvant chemotherapy, we examined the barriers and perceptions of 24 UK NHS multidisciplinary breast cancer teams to offering this treatment to women ≥70 years."
I'm probably biased and therefore might read things into this that aren't there, but to me, the statement that they're searching for 'barriers and perceptions' that stop doctors offering chemotherapy suggests that they'd already decided, before starting the study, that chemo should be offered more frequently. A slightly more 'open' phrasing would have been nice - maybe they could have examined 'if there are barriers to offering this treatment'.
Then, in the results of the abstract, it appears that of the women offered chemotherapy after surgery (14pc of the sample), only just over half decided to undergo it. For those not offered chemo, treatment teams overwhelmingly cited the availability of other treatments, or a lack of expected benefit from chemotherapy, as reasons for not offering it. Considering the study focuses solely on women over 70, surely the cost/benefit analysis should be taken into account before blindly arguing that the uptake of chemo should be improved? These women are likely to have different priorities, and face a different level of risk, than patients in their 40s and 50s. I have no idea whether the full report looks at the stage of cancer at diagnosis - the abstract certainly doesn't mention anything about it - but this would also be an important factor.
The researchers do make a valid point in the fact that the rates of chemotherapy offered to this group of patients varies strongly between health trusts, and this would be an interesting and important issue to look into. Another study I'd like to see would be a ten-year follow up study of breast cancer patients over 70 who have either received chemotherapy or not, in order to compare survival rates. Those figures would be necessary before it can be confidently argued that improving uptake of chemo is a good thing!
So, for a change I spent more time complaining about a study than about the Mail's coverage of it - most unusual, but I'm sure I'll be able to go back to my old ways soon enough...
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