Deaths from breast cancer fall in Europe

Improvements in treatment, as well as enhanced access to care, underlie the sustained decreases in breast cancer mortality seen in 30 European countries [1] from 1989 to 2010. But there are notable variations between different countries that cannot be explained simply by the resources devoted to cancer care, and these differences need to be studied further, according to research to be presented to the 9th European Breast Cancer Conference (EBCC-9) tomorrow (Friday).

Professor Philippe Autier, from the International Prevention Research Institute, Lyon, France, told a press conference that, although the decrease in deaths from breast cancer in 2010 was greatest in those countries with the highest mortality rates in the late 1980s, there were notable exceptions. "In 1987-9, rates in Italy, France and Norway were 29.7%, 28% and 27.4% respectively, but the respective declines in mortality rates 22 years later were 26.4%, 15.8%, and 34.5%, and of all European countries, the lowest mortality reductions in women aged less than 50 were also to be found in France," he said. "Given that France devotes substantial resources to cancer care and that Frenchwomen have access to the best treatment, there is something going on here that we don't understand and that needs urgent investigation."

In 1987-9 breast cancer mortality rates were highest in England and Wales at 41.9 per 100,000, and lowest, at 20 per 100,000 in Romania. In 2008-2010 these rates were 25.4 and 22 respectively, indicating that mortality decreased by 40.8% in England, while it increased by 11.4% in Romania.

"There are a number of possible reasons for these variations," Prof Autier will tell the conference. "For example, screening has played an important role in decreasing the average size of tumours at detection.

However, trends in the incidence of advanced breast cancer have remained stable, suggesting that screening does not succeed in detecting potentially life-threatening cancers at an earlier stage, and the number of breast cancers that have already metastasised in distant organs when first diagnosed has not decreased. Hence these reductions in size simply represent the increasing incidence of small, early, non life-threatening cancers that are detected by screening and which give an overall impression that things are getting better in terms of outcomes. As a result, we can say that decreased numbers of breast cancer deaths are largely due to improved treatments, not to screening."

Reductions in mortality from breast cancer were greatest in women of less than 50 years of age, with overall reductions of -71.3% to -21.4%, and smallest in women aged 70 and over (from -29.5 to + 81.5), with breast cancer mortality among older women continuing to increase in many countries, particularly those in central and eastern Europe. This can be mainly ascribed to the under-treatment, which is common among older women with breast cancer, the researchers say.

"Our study shows the value of using mortality rates to measure success in controlling cancer. Although survival rates can also be used for this purpose, they tend to cloud the true picture by being influenced by trends in cancer incidence," says Prof Autier. "In countries where there is much screening and thus where many small non-life-threatening breast cancers are found, survival statistics will also be better than in countries where screening is less common, not because of differences in breast cancer mortality, but because of differences in the incidence of small screen-detected cancers.