Convergence in Breast Cancer Treatment: Positive Impact of Globalization
By Jane Ricardson, Datamonitor
An estimated 400,000 women will be diagnosed with breast cancer in 1999 in the seven major markets of the US, Japan, France, Germany, Italy, Spain, and the UK. As one of the leading causes of death among women, breast cancer has an enormous impact not only upon the lives of patients and their families, but, increasingly, the national healthcare systems, which must meet the cost of treating this disease. Although there have been considerable advances in the treatment of breast cancer in the last five years, offering hope to many women with breast cancer, professionals remain divided as to the most effective form of treatment for the disease.
A new report by Datamonitor, Treatment Algorithms 1999: Segmenting the Breast Cancer Patient Population, reveals that:
- The treatment of breast cancer within the US, Europe and Japan differs widely, and is heavily influenced by both patients' and physicians' beliefs about the disease.
- Attempts at both a national and international level to standardize breast cancer treatment are beginning to have a positive impact.
- The treatment offered to women within the US, Japan, and Europe differs widely, and is heavily influenced by both patients' and physicians' attitudes to the disease.
Datamonitor's primary research within the US, Japan, France, Germany, Italy, Spain, and the UK reveals that despite advances in therapy and an upsurge in the level of information regarding treatment practice, the treatment of breast cancer both within and amongst these countries remains highly fragmented. In the absence of an accepted "gold standard" treatment for breast cancer, women are more likely to receive treatment based on physician's preference and perceptions of best treatment practice.
Specialists within all the countries studied stated that their choice of treatment was influenced predominantly by women's ages and the extent of disease progression at the time of diagnosis. However, despite this consensus, the treatment offered to womenand most noticeably older womenoften varies enormously. The treatment of breast cancer in both Spain and the UK is heavily influenced by patients' age at diagnosis, such that older women in these countries are less likely than those under age 50 to receive aggressive forms of treatment which could potentially promise cure.
Despite ongoing initiatives in all the countries aimed at raising patients' awareness and understanding of breast cancer, doctors commented that considerable fear and misunderstanding continues to exist about the various forms of treatment open to patients, particularly among older women. Thus, despite clear evidence that lumpectomies combined with radiotherapy are as effective as radical surgery in preventing the recurrence of some types of breast cancer, a substantial proportion of older women within Spain and the UK continue to choose mastectomies in the mistaken belief that this will prevent cancer recurrence.
The following diagram illustrates the form of treatment modality prescribed to postmenopausal women with advanced breast cancer in each of the seven countries:
Standardized Treatments Beginning to Take Hold
The absence of national guidelines in Japan and Europe for treating breast cancer means that the majority of physicians within these markets have historically followed locally generated procedures, which can vary substantially from region to region. Many European physicians also look to the US, the most fast moving and innovative of all the pharmaceutical markets, as a source of information and guidance around treatment. The last year has, however, seen substantial convergence in the treatment of breast cancer across all seven countries, not only in terms of the overall modality used, but also the drug regimens prescribed.
In part, this convergence can be attributed to the attempts of health care providers to regularize treatment at a national level. Most notably, in 1999 the UK Government pledged to end "postcode prescribing," which should go some way towards ensuring that women across the UK have equal access to particular drug regimens.
The standardization of breast cancer treatment is also being driven by a number of factors at an international level, including the advent of international physician organizations in which information about clinical research and new forms of treatment can be exchanged. Moreover, the internet has not only increased specialists' ease of access to research and treatment guidelines from other countries, but also communication between physicians, rendering differences in the treatment of breast cancer increasingly transparent. As a consequence, Datamonitor believes that the overall treatment of breast cancer within the US, Japan, and Europe will become increasingly standardized over the next few years.
Treatment Algorithms 1999: Segmenting the Breast Cancer Patient Population is available from Datamonitor for $6,995.
For more information: Jane Richardson, Analyst, Datamonitor, Charles House, 108110 Finchley Rd., Swiss Cottage, London, NW3 5JJ, UK. Tel: +44 20-7675-7000. Fax: +44 20-7675-7500.