You do the Maths!
Breast Cancer UK believes more can be done to prevent breast cancer but does the amount we spend on prevention add up?
Our ‘You do the Maths’ campaign asks whether we could invest more to help prevent breast cancer and highlights the comparatively tiny amounts currently spent on preventing and understanding the causes of cancers.
Why are more of us getting breast cancer?
There is growing global concern that exposure to harmful chemicals could be contributing to an increased risk of many diseases including cancers. In 2012, WHO/UNEP (2) published an assessment of the state of the science of endocrine disruptors. It noted three key areas of concern:
- many endocrine related diseases and disorders, including cancers, such as breast cancer, were on the increase;
- endocrine‐related effects had been observed in wildlife populations; and,
- the identification of chemicals with endocrine disrupting properties had been increasingly linked to disease.
Are we investing enough to find out what causes breast cancer?
We only know what causes around half of all breast cancers. It is estimated that 20-30% (3) of cases are due to genetic mutations. Of these, 2-3% are associated with BRCA mutations. The remaining 75% are thought to be attributable to environmental and lifestyle factors, including alcohol (6%), post menopausal hormones (3%), radiation (1%), being overweight (9%) occupational risk (5%) and lack of exercise (3%). This means that at least 45% have unknown causes (4). Despite this, in 2014, just 1% of UK research funding went towards breast cancer research to identify the environmental and lifestyle causes of breast cancers. In 2003 this figure was 6% (5).
Could we do more to prevent cancers?
Incidence rates for all cancers in Great Britain increased by 23% in men and by 43% in women during the period 1975-77 to 2009-11 (6). It is predicted that 1 in 2 people in the UK will get cancer at some point in their lives (7). Whilst we must prepare for the consequences of this upward trend, could we also do more to prevent it?
Only 3.5% of cancer research funding was spent on interventions to help prevent cancers in 2014 (8). Breast Cancer UK is calling for a commitment to increase this figure over the next 5 years to 5% and for research funding into the ‘Exogenous Causes of Cancers to be increased from 1.3% to 4.3% (the same level of funding as in 2002).
Could the burden on the NHS be reduced?
The costs to the UK of breast cancer alone, is an estimated £1.5 billion each year with the average 15-month health-care costs estimated to be £12,595 per-patient (9). The NHS will not be able to cope with the rising number of cancer patients. If we reduce annual breast cancer rates by just 10%, potential savings of around £51 million could be achieved. Meanwhile, the Cancer Drugs Fund is facing a £70 (10) million overspend. The life extending breast cancer drug, Kadcyla, has just been saved from being delisted but the question of whether patients will be able to access life saving drugs in the future remains in the balance (11).
What is Breast Cancer UK calling for?
Breast Cancer UK believes far more can be done to prevent breast cancer. We are calling for:
- An independent task force to review national research efforts and develop a comprehensive national strategy on environmental and genetic factors related to cancer;
- A commitment to develop and implement a primary cancer prevention strategy which commits to the improvement of our understanding of all of the causes of cancer and acknowledges the links between certain cancers and environmental pollutants;
- A commitment to an increase in cancer research funding over the next 5 years; and,
- A recommendation that NHS advice services publish advice for pregnant women on reducing in utero exposures to hazardous chemicals, including endocrine disrupting chemicals.
1. King et al. (2003). Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302(5645): 643-646
2. WHO/UNEP (2012). State of the science of endocrine disrupting chemicals.
3. Economopoulou et al. (2015). Beyond BRCA: New hereditary breast cancer susceptibility genes. Cancer Treatment Reviews 41: 1-8
4. Parkin et al. (2011). ‘The Fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010’ British Journal of Cancer 105, S77-s81
5. Source: NCRI Breast Cancer Spend 2002-2014
6. Cancer Research UK cancer incidence for all cancers combined http://www.cancerresearchuk.org/healthprofessional/cancer-statistics/incidence/all-cancers-combined (last accessed 13.11.15)
7. Ahmad et al. (2015). Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those
born from 1930 to 1960. British Journal of Cancer. 112(5): 943-947
8. NCRI Cancer Research database Latest data (2014) http://www.ncri.org.uk/what-we-do/research-database/ (last accessed 13.11.15)
9. Hall et al. (2015). Costs of cancer care for use in economic evaluation: a UK analysis of patient -level routine health
system data. British Journal of Cancer. 112(5): 948-56
10. https://www.england.nhs.uk/2015/09/04/update-on-the-current-cancer-drugs-fund-list/ (last accessed 16/11/15)
11. Kadcyle was reported by NICE to cost £90k pppy, https://www.nice.org.uk/news/article/pressure-grows-on-rocheto-lower-breast-cancer-drug-price. Although the new cost is not known it is reported to have been brought down to around £50k pppy. http://www.pmlive.com/pharma_news/price_cut_keeps_kadcyla_on_cdf_858809 (last accessed 16/11/15)