- Death rates from breast cancer have fallen markedly in Europe in the past 20 years thanks largely to better screening and treatment policies, with Britain and Iceland leading the way, scientists said on Thursday.

Researchers led by Philippe Autier from the International Prevention Research Institute in France looked at changes in breast cancer death rates in women in 30 European countries from 1989 to 2006 and found rates fell by around a fifth on average.

But breast cancer mortality in central European countries remained stable or in some cases rose, and the scientists said more efforts were needed to improve diagnosis and treatment to “reduce the avoidable breast cancer mortality” there.

Changes in breast cancer mortality ranged from a 45 percent decline in Iceland to a 17 percent increase in Romania, the scientists said in a study in the British Medical Journal.

England and Wales, Northern Ireland, and Scotland, had the second, third, and fourth largest decreases of 35 percent, 29 percent and 30 percent.

“Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions,” they wrote.

Experts commenting on this study, which used World Health Organization data on death rates, said it was more reliable than others that looked at cancer survival rates, since they could be skewed by changes in the number of cases of a disease.

Breast cancer kills around half a million people worldwide each year and is the most common type of cancer in women in wealthy nations.

Autier’s team said countries with large declines in death rates, such as the Britain, had benefited from comprehensive and organized screening programmes, and rapid and general use of the generic breast cancer drug tamoxifen as well as chemotherapy.

“At the other end of the spectrum, in central European countries the small decreases or the continued increase in breast cancer mortality were correlated with low, usually non-organized, screening activities, low numbers of mammography machines, slow uptake of anti-cancer drugs, and health expenditures below the European average,” they wrote.

But the researchers also noted that in some countries, such as France, Sweden and Finland, where health spending is relatively high and the focus on breast cancer screening and treatment had been good, death rates were falling less sharply than might have been hoped.

“The decline in breast cancer mortality in France has been quite modest despite this country having one of the highest number of mammography units per million women, having the highest spending on cancer drugs per person in Europe, being at the forefront in use of new costly treatments, and devoting much effort to enhancing adherence to guidelines,” they wrote.

Breast cancer deaths rates declines in Finland, France, and Sweden were 12 percent, 11 percent and 16 percent respectively.

SOURCE:  BMJ, August 12, 2010.