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Breast Cancer Awareness Month (October) does a valuable service in advising women of the disease’s early signs and symptoms, the need for screening and the achievements of research work into causes and treatment. If there is a criticism of the annual campaign it is that too many of the true stories told on TV, radio or in newspapers are preoccupied with the devastating effect of the diagnosis on patient and family.

Too few emphasise the high recovery rate that is usually achieved in patients who have followed a good screening programme such as the one recommended by the American Cancer Society (ACS). This is statistically better than that provided by the NHS. Patients following a first-class screening service, who, as a result, have a cancer diagnosed, can expect more than a 90 per cent chance of living a normal lifespan.

Another factor, which tends to overemphasise the death rate and underemphasise the successes, is that newspapers concentrate on glamor-ous young women with breast cancer. There is evidence that younger patients do less well and that the tumour may be diagnosed later. Breast cancer is predominantly a disease of older women, better portrayed by an actress in The Archers than a young Hollywood star.

The basic treatment is the surgical removal of the tumour, radiation therapy, and chemotherapy, which will vary depending on the nature of the tumour, and reconstructive surgery when it is indicated afterwards. Just as the ACS’s breast-cancer screening protocol is to be preferred, in my opinion, to that of the NHS recommendations, so some aspects of treatment in the US are superior to that of the NHS. Fifty years ago breast surgery had all the finesse of butchery. The extended radical mastectomy was followed by radiotherapy that burnt to a frazzle healthy tissue as well as the cancer. The advances and improved survival is marked by the introduction of Tamoxifen, aromatase inhibitors and chemotherapy, which are now more effective and have fewer adverse effects, and include such drugs as Avastin, Herceptin and lapat-inib for inflammatory breast cancer. Surgery is now more likely to be a lumpectomy, varying degrees of simple or total mastectomy rather than a radical. Sentinel lymph node biopsy as well as the pathologist’s report on the tumour gives the surgeon and oncologist the necessary knowledge needed to decide on the best follow-up treatment.

Radiotherapy now delivers a measured dose so that healthy tissue spared. Research is advanced at University College Hospital London on ways of giving radiotherapy at the same time as the surgery.

Some of the benefits enjoyed by patients here 50 years ago are still standard in the US. We congratulate ourselves that patients with probable breast cancer have to wait only a fortnight. This would have been considered a monstrously long time when I was a junior doctor. At the Mayo Clinic in the US patients are often admitted the day after diagnosis. Immediate frozen-section analysis of the breast tissue – removed during surgery to make certain that a segmental mastectomy or lumpectomy has not only removed the cancer but an adequate amount of healthy tissue as a safety zone around it – is now rarely, if ever, done on the NHS. Our authorities consider this an unnecessary expense as it is labour intensive, requiring the presence of a pathologist and technologist in the theatre and therefore adding to operating theatre time.

A frozen section confirms the adequacy of the operation within 20 minutes. If the margin of malignant-free tissue is too small it can be corrected at once. Waiting for laboratory results may take from several days to a couple of weeks. Even in good units about one woman in five will have had too little tissue removed if a frozen section is not performed so that a second operation with more radical surgery becomes necessary.

In the US, Harvard, the Mayo Clinic, the University of Florida Cancer Center and other well-known centres still use frozen sections. In this country the accepted NHS procedure is not to do so. Alas, some insurance companies use the NHS decision as an excuse not to pay the small extra cost a frozen section would entail for private patients insured with them. These companies must be aware that the Department of Health and NICE admit that their decisions on procedures have to regard cost as well as any patient’s welfare.

Private patients would be surprised if they knew that their health was not their insurer’s first consideration. They might be worried by not having a frozen section that could reduce reoperation rates from 20 per cent to less than 7 per cent. In a London private breast clinic that uses frozen sections the recurrence rate for years after surgery is 1.4 per cent; on the NHS the figure is 3 to 4 per cent.