Health

On my way home last week, I saw pink. In the newsagents, there were glossy rows of breast cancer magazines, pink and glistening slightly obscenely in the aisle. For this is October, breast cancer awareness month, and this is why there are Pink Aerobics, tandem Pink Parachute jumps, Pink Parties in offices, and Pink Pampering Evenings at home. When I got home, seeking televisual solace, I switched on to find the "Tickled Pink" concert, held at the Royal Albert Hall to raise money for breast cancer charities.

How could anyone object? Breast cancer is common, and becoming more so. But mea culpa, I object. And here's the question, the awfully unpopular question. Is it right that we devote so much of our time, effort and energy to focus on this one disease?

The first problem is "awareness". If you ask someone who has had a breast lump biopsied and proved not to be cancer, they will probably tell you that they are glad to have had the test and given a clean bill of health. They may feel relief; they may feel the brush with death and the subsequent clear results to be life-affirming and corner-turning. Yet most breast lumps - 90 per cent - are not cancer. We are told that one in nine women will get breast cancer at some point in life. However, you only reach that level of risk aged 85.

No wonder we're confused. A few months ago, the US journal Patient Education and Counseling published a paper showing most women overestimated their risk of getting breast cancer by about three times. Another US study found that women overestimated their chances of dying from breast cancer by more than 20 times. This surely isn't a level of "awareness" that is desirable.

The second problem is one of equity. The breast cancer juggernaut, when in town, outshines most other health charities. It is a female, sexy campaign capable of filling column inches. But how, for example, could research into bowel cancer ever be so glamorous? How could schizophrenia or dementia or hepatitis or prostate cancer ever get its own magazine in airports to promote it, or have a gala spectacular on prime-time television? It does not seem fair that research monies have to rely on the popularity of a cause rather than its proportional clinical need.

If we haven't already lost our critical abilities in the face of cancer, we are in danger of losing them. It is likely that the amount of breast cancer being diagnosed is higher than it was because of screening, which picks up some breast "cancers" that will never become life-threatening. We also know that at least some of the rise in breast cancer is conversely due to improvements in health - we are living longer, and age is the biggest risk of all for breast cancer.

This week a nurse won the right to have Herceptin, a drug trialled for use in the treatment of certain breast cancers, prescribed on the NHS, despite it not yet having a licence in the UK. Media reports of this drug typically stress its qualities as an "instant cure-all", "revolutionary" or a "magic bullet". And yes, it might be useful for some women: if you have breast cancer and are one of the 20-30 per cent of women who have HER-2 positive breast cancer (and the HER-2 test itself is only 80 per cent accurate).

Certainly this drug does have a benefit but rather less of a benefit than much of the media coverage of Herceptin would indicate. Data from trials in the US suggest that there is a benefit to mortality, but to date we only know the data for a relatively short period of time - about two years. The international HERA trial results so far show that after 24 months of using standard treatment, 77.4 per cent of patients were disease-free and alive. If Herceptin was used in addition, then the percentage of patients alive and disease-free after the same time was 85.8 per cent. And side effects of Herceptin are rare but serious: in the US, some women had to be removed from trials due to significant cardiac side effects. The full analysis from the HERA trial won't be available for two years. Getting decent data - not just benefits, but side effects - has to take time.

It isn't that Herceptin shouldn't be prescribed to those who would benefit from it. But the emotional overload surrounding breast cancer means that it is increasingly difficult to get good quality information to women, including all the negatives and uncertainties. We should have clean information without automatically induced anxiety. Then again, by insisting on such a rigorous, evidence-based approach, it inevitably means that I am the wallflower at this month's pink party.

For data on the HERA trial click here and look under ‘News’
For papers about women’s perception of risk in breast cancer from the National Center for Biotechnology information click here.
For more information on changing attitudes to breast cancer from Science Direct click here.
Information about risks of breast cancer from the NHS click here.

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