BREAST cancer sufferers in England are missing out on a leading drug that is available to all patients in Scotland because of disarray in treatment funding, it emerged yesterday.

A survey by The Times of England’s 34 cancer networks reveals the stark divisions in care, with some sufferers unable to get drugs shown to be the most effective treatment of the disease.

In other instances doctors and health trusts are ignoring the advice of the National Institute for Health and Clinical Excellence (NICE), which recommends on “best practice” for the NHS in England and Wales, by offering patients the drugs. The NICE has yet to approve them for use.

The “postcode lottery” will be highlighted further this morning with the announcement from the Scottish Medicines Consortium that Arimidex (anastrozole), one of the most promising drugs still yet to be approved, is to be recommended for patients in Scotland.

Arimidex has been shown to be 25 per cent more effective in post-menopausal women with early breast cancer than the most commonly used “best practice” treatment, tamoxifen.

Arimidex, which would be suitable for more than two thirds of the 40,000 people in Britain who have breast cancer diagnosed each year, also reduces the spread of cancer to other parts of the body by 14 per cent and cuts the chances of it recurring in the other breast by 40 per cent.

The NICE, which, in effect, determines NHS funding for drug treatments, is understood not to be making a decision on Arimidex for another 15 months after being forced to drop one of its appraisal committees because of government cuts. In a sign of the growing pressure on the Government and the NICE to improve access to treatment, CancerBACUP, the leading cancer charity, will publish a “dossier of delay” next week listing about 20 drugs still held up in the system.

Other drugs awaiting NICE approval include Femara (letrozole) and Aromasin (exemestane), two hormonal treatments similar to Arimidex.

Aromasin, said to cut the risk of relapse by almost a third, is available in Britain from today after being licensed for women who have undergone treatment with tamoxifen for two to three years after surgery.

Trials have shown that switching to Aromasin instead of continuing with tamoxifen for five years cuts the chances of cancer returning by an extra 30 per cent.

The chances of breast cancer appearing in another breast is reduced by half. Concerns about the lack of availability of Herceptin (trastuzumab), another effective medication for women with tumours of a certain genetic profile, recently prompted Patricia Hewitt, the Health Secretary, to fast-track its approval.

A survey by The Times of England’s cancer networks, which offer specialist advice to primary care trusts (PCTs) on cancer care, found striking disparities across the country, with some trusts offering drugs wherever suitable, others effectivly “rationing” them, and some not offering them at all.

Asked about usage of Arimidex, Femara and Herceptin, several networks, such as Mid Anglia and Dorset, said that PCTs under their watch used only the latter, in line with NICE guidelines.

Many other networks, such as Avon, Somerset and Wiltshire, which represents 12 PCTs in the West Country, said that Arimidex and Femara were offered only if patients could not tolerate tamoxifen.

Most said that such decisions were judged case by case, only used in exceptional circumstances or left to the clinician’s discretion.

Joanne Rule, the chief executive of CancerBACUP, said that patients around the country frequently called to ask about how they could obtain proven treatments that might help them to fight their condition.

“Sadly we have to tell them it could take years before they are widely available on the NHS,” Ms Rule said.

“For many that could be too late. That’s why a fast-track system is urgently needed for those cancer drugs which are recognised as potentially increasing survival rates and why the process needs to be generally speeded up for others.”

Additional reporting by Sara Black and Rhiannon James

www.timesonline.co.uk/health
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BREAST BATTLES

• Breast cancer affects more than 40,000 women each year with up to 13,000 deaths. In 80 per cent of cases the tumour is fuelled by oestrogen
  
• Tamoxifen blocks the cancer’s ability to respond to oestrogen, but cancer returns in 15 per cent of women within five years
  
• Arimidex/Femara/Aromasin: aromatase inhibitors with fewer dangerous complications than tamoxifen, though risk of osteoporosis. Often used in combination with tamoxifen, with significantly improved survival rates

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