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Breast cancer and rates of survival

In recent years, there has been considerable progress in the diagnosis, treatment and prevention of breast cancer.

We are better informed about the disease, we are less afraid to talk about it, and an increasing number of women are surviving after being diagnosed. As the taboo around the disease has dissolved, the number of deaths it causes has fallen considerably.

So what are we to make of the news Scottish women appear to be more likely to die within a year of discovering they have the disease than women in mainland Europe? The figures are in a study of the European Cancer Registry and show that the survival rates in older women in Scotland a year after diagnosis are about 3% behind the European average.

Dr Hilary Dobson, a consultant radiologist in Glasgow who has highlighted the figures ahead of a major conference in the city this week, says the study demonstrates that, while the number of women who survive five years with the disease in Scotland is on a par with the rest of Europe, on survival in the first year Scotland is not doing so well.

The critical question is why this should be so, and, as yet, there is no definitive answer, although Dr Dobson says there is some evidence women in Scotland are presenting later with the disease. If that is the case, it makes educating women about the first signs of breast cancer critical to improving survival in the first year.

Scotland has made good advances in this area. The 2012 campaign featuring the actress Elaine C Smith, for instance, was successful in highlighting the symptoms of breast cancer; so successful that many breast cancer services found it hard to cope with the increased number of women coming forward. Some health boards had to arrange extra clinics to cope.

There is also every chance that the campaign, and the resulting rise in women approaching the NHS, will have had a positive effect on the Scottish survival rates in the first year, although if that is so it will not be reflected in the figures highlighted by Dr Dobson. They relate to the period 2002-2007, well before the 2012 campaign was launched.

The Scottish Government has already shown its faith in the campaign by preparing another one encouraging women to come forward for screening. It is a welcome move, although more controversial, based on concern that an increase in screening can lead to an increase in the NHS treating women for tumours that would never become harmful.

This was apparently supported by the UK Government's Marmot Review which suggested screening can lead to about 4000 women every year aged between 50-70 having treatment for a condition that would never have troubled them.

However, such concerns are an argument for more effective screening rather than an argument for reducing it. We know identifying cancers early can be vital in dealing with more aggressive tumours and can reduce the need for radical surgery. We know that prevention is better than cure. It is that principle that holds out hope of improving Scotland's first-year survival rates on breast cancer.

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