Breast Cancer Awareness: The surgeon's story - 'Serious lumps are

The success of the NHS Breast Screening Programme and advances in treatment have cut breast cancer deaths by a third in the last 10 years. But the disease remains the most common cause of death in middle-aged women. And many doctors believe when it comes to Britain's record on cancer care, we're nothing more than a Third World country. Latest figures show that British women diagnosed with breast cancer have a 67 per cent chance of living for more than five years; but if they lived in Sweden, France, Switzerland or the US, it would be more than 80 per cent.

And even in this country, your chances of survival depend on where you live. Breast cancer patients in East Surrey have an 85 per cent chance of surviving for five years, while those in less affluent North Staffordshire only have a 65 per cent chance.

"Cancer survival is not a lottery," said Professor Michel Coleman in a recent Cancer Research Campaign report. "Lotteries are fair. A lottery ticket buys you the same chance of winning whether you are rich or poor and whether you live in Leeds or in London."

Women who are treated by a specialist breast cancer team, including a breast cancer surgeon, have a much greater chance of survival. Yet such is the current shortage of trained specialists, half the women diagnosed never get to see one. Not all women know they have the right to insist on being treated by a specialist team," says Adam Stacey-Clear, leading breast cancer surgeon at Surrey and Sussex Healthcare NHS Trust.

Adam, whose work helped the East Surrey Health Authority top the NHS league tables for survival rates in Britain, heads a team that sees up to 200 new cases each year.

"We have one-stop breast clinics where patients are seen by me, have either ultra-sound or a mammogram and a needle biopsy and get their diagnosis - all on the same morning. Patients not only have the benefit of my knowledge, but also the expertise of an oncologist, a radiologist, a pathologist, breast cancer care nurse and a psychiatrist."

Adam became passionately committed to trying to save the lives of sufferers after his mother died of breast cancer. "Every patient who comes to me is the most important case I have to deal with, because I have empathy as well as sympathy."

He believes reasons for lower survival rates in some areas include the lack of standardised treatment regimens and outdated equipment as well as the reluctance of some women to seek help soon enough.

"Some women hide the symptoms, even from their husbands. Others simply don't see their health as a priority, they put themselves after the needs of other family members.

"GPs are also encouraged to refer patients with suspicious symptoms to a specialist within two weeks but this is not always happening.

"Serious lumps are still escaping. The diagnostic abilities of GPs hasn't changed. Often the GPs believe the lump to be benign and one in 10 is not."

Drugs used to treat advanced cases, such as Taxol and Taxotere can increase patients' survival by months, even years. Because they can cost up to pounds 10,000 a treatment, some health authorities banned them. But the Government's National Institute For Clinical Excellence (NICE) recently recommended that all breast cancer patients receive the drugs on the NHS - regardless of where they live.

"The good news is that already seems to be happening," says David Turner, of The Campaign For Effective And Rational Treatment. "The Government also pledged pounds 660million to improving all cancer services. We would like all health authorities to spend this not just on drugs but on equipment and training so everyone will have automatic access to a specialist team."

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