Poor Progress in Breast Cancer Control in the Elderly in the UK.

Background:In 1998 England introduced a national cancer target, to reduce cancer mortality in the under 75 year olds from 1996 to 2010 by 20%. This might potentially lead to inequalities between younger and elderly cancer patients. In this study we assessed progress in breast cancer control in the elderly in the UK by comparing cancer mortality rates in the elderly with younger age groups in the UK and by comparing the elderly in the UK with other similar countries.Material and Methods:Mortality data for the UK, USA, Northern Europe (Denmark, Finland, Iceland, Sweden and Norway) and Western Europe (Germany, Netherlands, Luxembourg, Austria, France Switzerland) was obtained from the WHO mortality database. Age specific cancer mortality rates for the age bands 55-64, 65-74, 75-84 and 85 plus were calculated for the different geographies for the three year periods 1995-97 and 2003-05. Change in the differences between the age bands was assessed as the ratio between the youngest age group 55-64, which was set to 1, and the older age groups. The number of excess deaths in the UK was calculated by applying the lowest rate observed in each age band to the UK population, assuming that the UK could achieve the same rate.Results:Compared to other countries the UK had the highest breast cancer mortality rates in all age bands in 1995-07 and 2003-05 and rates were statistically significantly higher in 2003-05 at the 95% Confidence interval limit. In the younger age groups (55-64 and 65-74) the UK had the biggest decrease from 1995-97 to 2003-05 and is decreasing the gap to the other countries. In contrast the UK was the only geography with an increase in mortality rates in the over 85 year olds and only ranked second after the USA in the 75 to 84 year olds. If the UK had the same mortality rates as the lowest observed in each age band 681 breast cancer deaths could be prevented in the 55 to 74 year olds and 1590 in the over 75 year olds each year. The UK also had the greatest increase in the ratio between the 55-64 year olds and 85plus year olds, with and increase of a 100% from 3.5 to 4.5 from 1995-97 to 2003-05. The USA had the lowest rates in each age group.Conclusion:Little progress has been made in decreasing breast cancer mortality rates in the elderly in the UK. The gap in breast cancer mortality in the elderly compared to the younger age groups as well as the other countries is increasing. The gap with other countries will be closed only if there is a marked decrease in death rates in the over 75s. Future analysis should also look at the causes of higher mortality in the UK, taking the USA as the gold standard. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2059.