A survey of the management of breast cancer in England and Wales

Harries, Simon; Scrivener, Ross; Kissin, M.W.

doi:10.1016/0959-8049(94)90750-1

Cited by 5 publications

(8 citation statements)

References 20 publications

(25 reference statements)

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“…The failure to deliver adjuvant chemotherapy to pre-menopausal node-positive women, which the overview of adjuvant chemotherapy shows to have a survival advantage, is similarly disadvantaging women (Early Breast Trialists Collaborative Group, 1992). This and the survey of Harries et al (1996) reinforce the view that patients should be seen in multidisciplinary teams of surgeons, radiologists, pathologists and oncologists for an initial decision on management once the diagnosis has been established.…”

Section: G U E S T E D I T O R I a Lmentioning

confidence: 58%

“…In breast cancer, the commonest malignancy affecting women in the UK, consensus management is much less frequently practised despite the availability of widely publicized guidelines on management. Harries et al (1996) have conducted the largest survey of the management of breast cancer in England and Wales. This was a questionnaire survey carried out in 1992 covering the advice the surgeon would offer on diagnosis, management of the primary tumour, the axilla, the elderly, treatment of recurrence, and frequency of, and investigations during, follow-up.…”

Section: G U E S T E D I T O R I a Lmentioning

confidence: 99%

“…It seems likely that the small proportion not offering breast-conserving therapy do not work in multidisciplinary teams where awareness of the literature and participation in clinical trials tends to be higher. Studies such as these may be biased by the limited response rate, typically about 60% (Gazet et al 1985;Morris et al 1989;Harries et al 1996). More weight should be given to studies based on cancer registration data which report on the whole of the population and the treatment that they actually received.…”

Section: G U E S T E D I T O R I a Lmentioning

confidence: 99%

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Variations in the management of cancer in the NHS: a legitimate cause for concern?

Kunkler

1997

Evaluation Clinical Practice

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Wide variations still exist in the UK in the management of common cancers in adults. Comprehensive high-quality audit data are needed to relate variations in outcomes to differences in clinical management. The management of cancer in the elderly is often difficult due to co-morbidity. Access to oncological advice should be available to all patients irrespective of age. Development of and adherence to nationally agreed treatment protocols is a key measure in reducing variations in treatment and in outcomes for patients with cancer.

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Section: G U E S T E D I T O R I a Lmentioning

confidence: 58%

Section: G U E S T E D I T O R I a Lmentioning

confidence: 99%

Section: G U E S T E D I T O R I a Lmentioning

confidence: 99%

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Variations in the management of cancer in the NHS: a legitimate cause for concern?

Kunkler

1997

Evaluation Clinical Practice

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“…Trials rarely include more than a small fraction of patients with a given cancer, and incorporation of the results into routine clinical practice can be slow, either because of delay in acceptance or lack of equipment or resources [21]. Trials often exclude elderly patients [22], even though opinion varies widely on how to treat breast cancer, both for elderly women [23] and for those under 50 years old [24], and older patients are less likely to be referred for specialist advice [25]. For all these reasons, cancer survival among patients recruited in clinical trials is inevitably higher than the average for all cancer patients.…”

Section: Full Textmentioning

confidence: 99%

“…Treatment protocols for breast cancer vary widely, and adherence to guidelines in the UK appears poor [23,32,42]. The UK boasts fewer oncologists per head of population than most comparable European countries [43], and there is some evidence that breast cancer survival depends on access to a specialist [44].…”

Section: Full Textmentioning

confidence: 99%

Opinion: why the variation in breast cancer survival in Europe?

Coleman

1999

Breast Cancer Res

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Breast cancer is the commonest malignancy among women in most European countries. Given current patterns of occurrence by age, about one in 12 women will develop the disease before the age of 75 years (lifetime risk around 8%), and it typically accounts for 20% or more of all cancers in women [1]. Breast cancer is thus a major public health problem, but with the exception of oral contraceptives and hormonal replacement therapy [2,3], both of which also have clear benefits, the known major risk factors are not amenable to primary prevention. Mass screening of women over age 50 years by mammography has been shown to reduce mortality [4]; national mammographic screening programmes were introduced for women aged 50-64 years in the UK from 1988 [5] and for women aged 50-70 years in The Netherlands from 1990 [6], and a regional scheme in Denmark was started in 1991 [7]. Opportunistic screening is also widespread in many European countries. The incidence of breast cancer has been increasing in many countries [1,[8][9][10][11]], but the available treatments have improved [12], survival has improved [13,14] and mortality has begun to decline [15].Until recently, international comparisons of regional or national survival estimates within Europe were bedevilled by the lack of comparability of data and methods. Within the past 5 years, however, evidence of international differences in survival from breast cancer [16][17][18] (and many other cancers) in Europe has begun to emerge from the EUROCARE (European Cancer Registry-based study of survival and care of cancer patients) study. (The author has been a member of the EUROCARE Project Management Group since 1989, and is a co-author of various publications emanating from the project.) In this article, the evidence for these differences in breast cancer survival among women in Europe is reviewed, and some of the possible explanations are considered, with particular reference to the patterns of survival in the UK and the extent to which they differ from those of other countries in Europe.The EUROCARE study now covers 17 European countries and is the largest international study of cancer survival. It includes 3.5 million cancer patients who were diagnosed between 1978 and 1989, and who have been followed up for at least 5 years, until the end of 1994 [19]. Data supplied in a standard format by 45 cancer registries covering a total population of about 100 million have been subjected to central quality control and analyzed using standard methods [20]. Relative survival up to 10 years after diagnosis by age, sex and country has been estimated for each of 45 cancers in adults aged 15-99 years at diagnosis.For women diagnosed with breast cancer during the period 1978-1985, 5-year survival in 12 countries up to the end of 1990 ranged from 76% in Switzerland to 44% in Poland (Fig. 1a). In Switzerland and Finland, survival was significantly higher than the weighted European average for participating countries, and significantly lower in England, Scotland, Estonia and Poland [16].Detaile...

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Follow-up strategies for women treated for early breast cancer

Moschetti

Cinquini

Lambertini

et al. 2016

Cochrane Database of Systematic Reviews

149

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Cochrane Database of Systematic Reviews analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for one trial of these trials, and no significant di erences in overall survival were found. No di erence was noted in quality of life measures (one study, 639 participants, high-quality evidence). The new included trial, together with a previously included trial involving 1264 women compared follow-up performed by a hospitalbased specialist versus follow-up performed by general practitioners. No significant di erences were noted in overall survival (HR 1.07, 95% CI 0.64 to 1.78, one study, 968 participants, moderate-quality evidence), time to detection of recurrence (HR 1.06, 95% CI 0.76 to 1.47, two studies, 1264 participants, moderate-quality evidence), and quality of life (one study, 356 participants, high-quality evidence). Patient satisfaction was greater among patients treated by general practitioners. One RCT involving 196 women compared regularly scheduled follow-up visits versus less frequent visits restricted to the time of mammography. No significant di erences emerged in interim use of telephone and frequency of general practitioners's consultations. Authors' conclusions This updated review of RCTs conducted almost 20 years ago suggests that follow-up programs based on regular physical examinations and yearly mammography alone are as e ective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life. In two RCTs, follow-up care performed by trained and not trained general practitioners working in an organised practice setting had comparable e ectiveness to that delivered by hospital-based specialists in terms of overall survival, recurrence detection, and quality of life.

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A survey of the management of breast cancer in England and Wales

Cited by 5 publications

References 20 publications

Variations in the management of cancer in the NHS: a legitimate cause for concern?

Variations in the management of cancer in the NHS: a legitimate cause for concern?

Opinion: why the variation in breast cancer survival in Europe?

Follow-up strategies for women treated for early breast cancer

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