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Britain’s two leading cancer research charities have called for guidelines
for doctors on the treatment of breast cancer. The calls follow the publication
of the first clear evidence that certain treatments given after surgery
do bring benefits. But the Department of Health has said that the choice
of treatments ‘is a matter for the profession’.

An analysis of 133 clinical trials worldwide by researchers in Oxford
shows that hormonal treatments and cell-killing drugs used alongside surgery
could save some 10 000 lives each year (see This Week, last issue and ‘Breast
cancer: turning figures into facts’, this issue). But many women do not
receive the best treatments, say the cancer charities.

Gordon McVie, scientific director of the Cancer Research Campaign in
London, says the variability in the standard of treatment around Britain
is ‘quite unacceptable’. He is ‘strongly in favour’ of guidelines that would
at least set the minimum acceptable standards.

A spokeswoman for the Imperial Cancer Research Fund (ICRF) says the
fund would also like to see guidelines for treatment. These should provide
information rather than prescribe rigid treatments: for example, they should
summarise the latest research and should interpret the findings for doctors.
If doctors decide that the preferred treatments are not appropriate for
a particular woman, they would be encouraged to record the reasons for this
decision in the patient’s notes.

However, the ICRF stresses that all women are different and each patient
and her doctor should decide on the precise course of treatment. For example,
destroying the ovaries of younger women with breast cancer has been found
to increase the chances of surviving 10 years after surgery. But this treatment
would obviously not be appropriate for women who want to have children.

Richard Peto, head of the ICRF’s Cancer Studies Unit in Oxford, which
led the study, says doctors should have information about research but is
strongly opposed to giving them ‘instructions’ for treatment. ‘I don’t want
us to move towards a state of defensive medicine,’ he says.

Even within the clear results published this month, he says, doctors
may vary in their interpretations. For example, some prefer to give women
the hormonal drug tamoxifen for two years, some for three or even five.
Ultimately, woman’s choice must come first.

The Department of Health says it welcomes the findings and 15 studying
them in detail, but so far it has shied away from the idea of guidelines.
‘The use of different treatment regimes is a matter for the profession,’
it says. Nevertheless, the department’s new director of research and development,
Michael Peckham, is investigating the best mechanisms for ensuring that
proven methods of treatment are introduced into the health service.