Best cancer care 'not guaranteed'

Hospitals are not taking the steps needed to guarantee women the best treatment for breast cancer, it has been claimed.

A survey found 74% of 100 leading UK breast cancer centres had not conducted audits ensuring compliance with national guidelines.

The NHS efficiency watchdog the National Institute for health and Clinical Excellence (Nice) issued new guidance for breast cancer treatment in 2006.

It said women taking the drug tamoxifen for hormone-sensitive breast cancer should be switched to an aromatase inhibitor (AI) after two to three years. AIs, such as the drug Aromasin, suppress production of the female sex hormone oestrogen, which fuels the growth of most breast tumours.

The guidelines were based on trial evidence which showed that switching to an AI could reduce a woman's risk of dying by 17%, compared with staying on tamoxifen for five years.

A majority of the 100 specialists surveyed believed their patients were receiving the best recommended treatment. But just 21 said their hospital had conducted an audit on breast cancer care while five did not know if one had been carried out.

Anthony Skene, consultant surgeon at the Royal Bournemouth Hospital NHS Foundation Trust, who took part in the research, said: "It is worrying that only a fifth of high-volume hospitals have undertaken an audit to confirm whether women are getting access to an AI, in line with Nice guidance."

The survey also found that more than 20% of hospitals had not briefed all staff members managing the follow-up treatment of post-menopausal women with breast cancer about treatment guidelines. Twelve per cent had no guidelines of their own at all.

Mr Skene added: "From these findings, it's unlikely that even high volume hospitals have mechanisms in place to recall women currently on tamoxifen to discuss switching to an AI with them. We can assume that women are slipping through the system and not being offered the optical treatment in line with Nice guidance."

Dr Mary McCormack, consultant clinical oncologist at University College London, another member of the survey team, said: "Aromatase inhibitors have given us an additional option in the management of oestrogen-receptor positive breast cancer in post-menopausal women and they have a definite role in line with the Nice guidance."

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