Breast removal for cancer is postcode lottery, study shows

Women with breast cancer are five times more likely to undergo a mastectomy rather than have less invasive surgery in some parts of the country compared with others, research has shown.

Sufferers living in some parts of the North are far more likely to undergo the major operation, rather than having the “breast conserving” surgery more common elsewhere, according to NHS figures revealing a “postcode lottery” in cancer care.

Statistics showing the ratio of mastectomies to less invasive procedures to treat breast cancer, show that Redcar and Cleveland, in the North East, is the place where patients were most likely to have at least one breast removed.

Those in the London borough of Richmond and Twickenham were the most likely to receive treatment which removed just part of their breast, with radiotherapy used to prevent the spread of tumours.

The statistics show that those living in Wolverhampton, West Midlands, the London borough of Kingston, South Staffordshire and Telford in Shropshire were also more likely to have mastectomies.

Research has found that for many women with breast cancer, either treatment has a similar survival rate, if the tumour is of a size where it can be removed without the whole breast being lost. The chance of drastic surgery was highest in the North. 

Women living in Redcar and Cleveland, in the North East, were five times as likely to have their whole breasts removed, rather than part of them, compared with those living in Richmond and Twickenham.

Those in Ashton, Leigh and Wigan, in the North West, Middlesbrough, in the North East and Bassetlaw in Nottinghamshire were also most likely to have mastectomies.

The new NHS figures, placed in the House of Commons library, show massive variations in practices across the country. Analysis found no relationship between the patterns and rates of survival in different parts of the country.

Experts said it was impossible to know from the data whether the massive discrepancies reflected the choices made by women from different areas, or pressure put on them by surgeons.

Cancer charities urged surgeons working in the areas most likely to carry out mastectomies, to carry out further investigations.

Women with breast cancer should be offered the option of mastectomy, or less invasive surgery backed by radiotherapy. Research has shown that for most women, the survival chances are similar, although those with larger tumours may have no choice but have the more drastic operation.

Meg McArthur, from Macmillan Cancer Support, said: “These variations are really substantial, and they really do require further investigation. In some cases – such as the way a tumour is positioned, women would have no choice but to have a full mastectomy, but that really wouldn’t explain the scale of the difference shown here.”

She said it was vital that women diagnosed with breast cancer were given full information about the risks and benefits of different treatments.

“I would want all surgeons to look closely at these figures, and for primary care trusts to examine them closely too,” Miss McArthur added.

Dr Jane Maher, chief medical officer for Breakthrough Breast Cancer, said it should not be assumed that women in areas most likely to have mastectomies were necessarily being put under pressure to undergo the procedure. Many women given information about the risks and benefits of both procedures chose the more drastic surgery, because they felt more able to put their fears behind them if they took the most extreme option.

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