Vancouver – Why is the death rate for women with breast cancer 13 per cent lower in B.C. than the national average, even though more women develop the disease here than anywhere else in Canada? A National Cancer Institute of Canada (NCIC) study has found one factor in B.C’s consistent cancer treatment and care.

The NCIC study compared breast cancer treatment guidelines and practices in B.C. and Ontario, including drug therapies and surgical procedures, to assess whether or not they improve the care women with breast cancer receive. The study, published in May in the British Journal of Cancer, showed treatment was more consistent in B.C. than in Ontario and that provincial guidelines contribute to the consistency. Doctors throughout the province receive the BC Cancer Agency Cancer Treatment Policies Manual, the only one of its kind in Canada.

What does this mean for women with breast cancer? “More women consistently receive good care here,” says Dr. Ivo Olivotto, a BC Cancer Agency radiation oncologist. Olivotta, Dr. Greg Hislop and Dr. Andy Coldman, all of the BC Cancer Agency, co-authored the study with Dr. Carol Sawka and Dr. Vivek Goel of the Toronto-Sunnybrook Regional Cancer Centre and the University of Toronto.

“If you have breast cancer, this is a good province to have it in,” says Dr. Susan Harris, 49, a breast cancer survivor and a professor in Rehab Sciences at the University of British Columbia currently researching the rehabilitation of women with breast cancer. In 1994, a mammography test revealed a tumor in Harris’s breast. It was cancer. She underwent a lumpectomy and radiation but, due to the tumor’s small size, no anticancer drug therapy. That’s the treatment that BC Cancer Agency guidelines recommended. She says the decision not to have the drug therapy affected her quality of life. “As a researcher, I respect the BC Cancer Agency guidelines because they are based on evidence.”

The study also found B.C. women at high risk of cancer recurrence were more likely to receive anticancer drug therapy and those at low risk were less likely to receive it compared to Ontario women. For instance, 82 per cent of women under 50 in B.C. at high risk of recurrence received anticancer drugs, which the guidelines recommended, when only 42 per cent of Ontario women in this age group received this treatment. Findings also showed 85 per cent of B.C. women under 50 at low risk of recurrence did not receive anticancer drugs, a guideline recommendation, compared to 70 per cent who did not in Ontario. Similar differences in the use of tamoxifen, an anticancer drug for breast cancer, appeared in the treatment of older patients.

“There is always room for improvement,” says Olivotto, head of the BC Cancer Agency breast tumor group. “In B.C., across all ages, 80 per cent received chemotherapy and 70 per cent received tamoxifen when the guidelines recommended these treatments. We want 100 per cent of patients to receive recommended treatments.

“Some patients aren’t being referred to an oncologist and there are delays in the adoption of current guidelines in the communities,” Olivotto continues. “If we educate general practitioners, surgeons and patients to be aware of provincial recommendations, we will further improve the consistency of care.”

The BC Cancer Agency is able to deliver consistently good care to cancer patients across the province due largely to its tumor groups. Each tumor group – consisting of medical and radiation oncologists, surgeons, a pathologist, a radiologist, a nurse, dietitian and a counselor – monitors a major cancer site, such as breast, prostate, or lung. The groups established provincial cancer treatment guidelines in 1974 and have updated them ever since. Olivotto says the system has lead to a more targeted use of therapy in B.C., and that this approach will likely improve cancer control rates and reduce the toxicity of treatments. The tumor groups are examining the process for updating guidelines to ensure the involvement of communities and that treatment recommendations evolve to reflect the latest research in a timely fashion.

More than 18,000 women in Canada will be diagnosed with breast cancer in 1997.

The BC Cancer Agency has a mandate to provide a comprehensive cancer control program for the province. It works closely with community partners to deliver a wide range of oncology services to patients throughout British Columbia, including prevention, early detection, diagnosis and treatment, research, education, supportive care, rehabilitation and palliative care.

Contacts: Libby Brown, Public Relations at 877-6107.