Women are more likely to die early in Britain than in virtually every other western European country. It’s an astonishing fact for a place which has always prided itself in the skill of its clinicians and world-leading research.
Yet over the past 40 years there has been an astounding downward spiral in female survival rates in the UK compared with other countries.
According to the respected medical journal The Lancet, British women have fallen from 15th to 20th place in a league of death rates in 22 western European nations (the report investigated deaths from disease as well as fatalities in accidents and childbirth).
Overall, fewer women are dying earlier, however, in the UK survival rates are not improving as fast as they are elsewhere.
How could this have come to pass – especially when there has been a steady rise in the amount of money spent on health by Government?
The fact is, while the amount spent here has risen from 6.8 per cent of our national income in 1997 to about 8.7 per cent in 2008, other countries such as France and Germany still spend more as a percentage.
Leading cancer specialist Professor Karol Sikora says: ‘It’s tragic and outrageous that the NHS has tripled its spending over the past decade and yet – due to bloated and unnecessary administration and poor policy such as artificial targets – we still perform so badly.’
A lack of resources is partly to blame for our poor results. An extensive study last year found that in Britain there are 8.2 MRI and CT scanners per million people; the European average is 11.
There are also far fewer doctors in Britain: 2.5 per 1,000 population, compared to 3.4 in France, for instance. This causes delays in diagnosis.
Just as significant is NHS rationing of lifesaving drugs – for example, the bowel cancer drug Avastin and Nexavar, the only treatment offering any chance of survival for patients with advanced liver cancer – are routinely used in other European countries.
These drugs typically offer three to six months of extra life, but some patients can survive for years. Although the drug-approving body NICE agrees they work, it says the health system cannot afford them.
Despite the much-heralded reduction in waiting times, these patients often wait longer between scanning, diagnosis and treatment than in other European countries.
In France, for instance, the investigation for breast cancer – the appointment, scan and diagnosis – is all done within 48 hours, says Professor Sikora.
‘Here we have a long, drawn-out appointment system where patients wait to see a doctor, then a specialist, then for the CT scan and then the results. It can all go on for months – allowing time for cancer to spread and become more difficult to treat.
‘The Government prides itself with the fact that suspected cancer patients can see a specialist within two weeks of their GP deciding they need a referral.
‘It is the curse of the British public sector that everything involves waiting – even though we have a good breast screening programme.’
The good news is death rates for most cancers are falling; however, we still lag behind most of Europe.
A damning league table, compiled by the highly respected Eurocare-4 study, ranked Britain 14th of 19 European countries in a survey of five-year survival rates for any cancer (that is survival for five years or more from diagnosis).
Expenditure is an issue – 5 to 6 per cent of NHS expenditure goes on cancer, compared with 7 per cent in France and 9 per cent in Germany.
Another issue is the need for better early diagnosis at GP level, say experts. This is partly a training issue, but it also reflects GPs’ reluctance to refer because of costs.
The reason that small countries such as Iceland fare better than us, say experts, is that patients are in a progressive healthcare system, looked after by a greater number of doctors.
A flawed health service can only be partly to blame for the UK results, as it seems lifestyle factors – such as smoking and obesity – are also responsible for driving up our incidence rates.
But it’s not all gloomy news, for in some diseases, such as heart disease, the picture in Britain is improving – indeed there are now fewer women dying younger than ten years ago.
In a unique piece of research, Good Health has trawled the very latest, authoritative pan-European statistics to pinpoint exactly where – and why – the story for British women is so bad. As well as the Eurocare-4, we consulted the European cardiovascular disease statistics project, focusing on the biggest killer diseases.
We then asked leading experts to explain what needs to be improved if we are to start saving more women’s lives.
Ovarian cancer
Ovarian cancer is notoriously difficult to treat since symptoms often don’t emerge until the disease is quite advanced, as the ovaries are deep in the pelvis, explains Professor Karol Sikora.
A tumour can grow to the size of a grapefruit before the cancer becomes obvious.
Late diagnosis is the real issue in the UK, adds Professor Hani Gabra, director of the ovarian cancer action research centre at imperial College in London.
‘This is not about lack of drugs – though we have fewer oncologists than in other countries such as Germany and Switzerland, which means patients may get less time with their doctor.’
He says the pressing issue is raising awareness, making GPs and patients aware that symptoms such as constipation and bloating are not necessarily bowel related, but could be a sign of ovarian cancer.
‘We then need to fast-track diagnostic tests for women presenting to their GP with symptoms that may suggest ovarian cancer.
‘At the moment it’s harder for GPs to make referral s when they are unsure of symptoms because PCTs are trying to save money by reducing the number of referrals GPs are allowed to make.
It is bureaucratic madness. Women’s chances of surviving ovarian cancer greatly improve if the disease is diagnosed early, so prompt referral by GPs could play a significant role in improving the UK’s poor survival rates.’
A recent study revealed that GPs are less likely to refer older women with suspected ovarian cancer for investigation – even though four out of five cases are in women over 50.
Our survival rates for cancer generally are among the lowest in Europe, but particularly for older people, and age-bias could explain why we lag behind countries such as Malta and the Czech republic.
‘Because we are seeing women at a much later stage of the disease, we need to use chemotherapy more aggressively, like they do in other European countries,’ says Professor Sikora.
Stroke
Cardiovascular disease – heart disease and stroke – is the main cause of death in women in Europe. Strokes are usually treated with anti-clotting drugs within three hours, a technique known as thrombolysis.
In most western European countries, up to 30 per cent of patients receive thrombolysis.
Only about 1per cent were receiving it in the UK until recently. Clot-busting drugs ‘need to be given by an expert who understands how to administer the medication,’ says Dr Tony Rudd, a stroke physician at guys and St Thomas’s Trust, London.
The problem is our lack of specialist stroke centres – these offer specialist care, such as scanning and medication, and rehabilitation. All of which make a difference to survival and recovery.
Another issue is a shortage of brain scanners – while patients in most European countries are scanned at the earliest opportunity, many in the UK wait as long as 24 hours.
Improvements are slowly being made to treat patients more effectively, notably the drive to take patients straight to specialist stroke centres rather than their local hospitals, even if they are out of the area.
This is already happening in Germany and France (explaining their overall survival rates).
‘Stroke treatment is good in this country once the patient receives it, but the vital aspect that still needs pushing is to act quickly,’ says Dr Rudd.
‘This means training paramedics to do tests to determine whether a person has had a stroke and encouraging patients to forget their GP and call an ambulance straight away.’
Breast cancer
More British women are diagnosed with the disease than in any other country in Europe. This may be linked to lifestyle factors such as weight gain and alcohol consumption – we drink more than other European women.
Improvements in early detection through the national screening programme mean breast cancer survival rates are better than lung cancer.
But what holds us back is a slow diagnostic system, says leading cancer specialist Professor Karol Sikora.
‘Patients wait to see a doctor, then a specialist, then for the CT scan and then the results. yet in countries such as France, the investigation – the appointment scan and diagnosis – is all done within 48 hours.’
We also use a smaller range of chemotherapy drugs and less aggressively than European oncologists, says Professor Sikora. In Europe they will continue to give patients chemo, even when there are serious side- effects – here, specialists might not.
‘We also use radiotherapy less and the quality of our technique isn’t as good as many places in Europe where precision radiotherapy targets a cancer without damaging surrounding tissue. This means they are more likely to use more extensive radiotherapy.’
Lung cancer
Lung disease is the biggest cancer killer of UK women – not surprising since a quarter of them smoke, more than in other European countries, with smoking on the increase among younger women.
Research has shown that women are more vulnerable to lung cancer than men and tend to be diagnosed at a younger age – even though they had smoked fewer cigarettes – possibly because nicotine triggers a gene which drives cancer growth.
Our mortality figures are particularly poor compared with countries such as Scandinavia and France, explains Dr Jesme Fox, medical director of The Roy castle Lung cancer Foundation.
‘Late diagnosis is a major factor in our relatively poor lung cancer survival figures.
‘A big problem is that patients delay seeing a doctor if they have, say, a persistent cough, a possible symptom of the disease, as they won’t associate it with cancer the way they would a breast lump.
‘And once they do get in the system, it takes so long to be diagnosed, scanned and treated that it can compromise survival.’
So although French women are also big smokers, their treatment in terms of waiting time as well as the use of chemotherapy is more advanced; so survival rates are better.
The National Lung cancer Audit revealed that people get worse treatment for lung cancer in the UK than many areas of Europe.
For example only 10per cent of British patients have surgery, which is the main way of tackling the disease.
Rates in Europe vary from 17.5 per cent to 25 per cent. Access to drugs such as Iressa – said to increase the time certain lung cancer patients survive without their disease worsening – have been approved in Europe while NIcE has still to make up its mind.
Heart disease
Coronary heart disease is the UK’s biggest killer, with one in every six women dying from the disease.
Over the past ten years there have been improvements in mortality rates thanks to better access to treatment and preventative treatment such as angioplasty, explains Dr Mike Knapton, of the British Heart Foundation. These have halved deaths from 20 per 100,000 to 11.
Taking the lead from other European countries, there’s now rapid access to a coronary care unit – so no delay in diagnosis and therefore greater chance of survival.
A steady increase in the number of cardiologists as well as an increase in the use of preventative drugs, such as statins has also had an impact.
However, three times as many women still die in Britain compared with France, which Dr Knapton says is driven by the number of people developing heart disease.
‘One reason for this is that the UK consumes more energy from fat than the European average.
‘This raises cholesterol, blood pressure and the risk of diabetes – all of which can lead to heart disease.’
A Mediterranean diet includes more monounsaturated fats, fruit and vegetables.
Ovarian cancer is notoriously difficult to treat since symptoms often dont emerge until the disease is quite advanced, as the ovaries are deep in the pelvis
