Cancer outcomes in the U.S.A vs. the U.K. - and other countries

There was a good op ed in the WSJ yesterday, but unfortunately it is in the subscriber-only section of the online edition. the link is below, along with excerpts, and anyone wanting the complete article can email me, and I will forward it.

Cancer Killers Cancer Killers - WSJ.com

The evidence shows that universal health coverage does not improve survival rates for cancer patients. Despite the large number of uninsured, cancer patients in the U.S. are most likely to be screened regularly, have the fastest access to treatment once they are diagnosed with the disease, and can get new, effective drugs long before they're available in most other countries.

Last month, the largest ever international survey of cancer survival rates showed that in the U.S., women have a 63% chance of living at least five years after diagnosis, and men have a 66% chance -- the highest survival rates in the world. These figures reflect the care available to all Americans, not just those with private health coverage. In Great Britain, which has had a government-run universal health-care system for half a century, the figures were 53% for women and 45% for men, near the bottom of the 23 countries surveyed.

A 2006 study in the journal Respiratory Medicine showed that lung cancer patients in the U.S. have the best chance of surviving five years -- about 16%. Patients in Austria and France fare almost as well, and patients in the United Kingdom do much worse with only 5% living five years. A report released in May from the Commonwealth Fund showed that women in the U.S. are more likely to get a PAP test every two years than women in Australia, Canada, New Zealand and the U.K., where health insurance is guaranteed by the government. In the U.S. 85% of women ages 25-64 have regular PAP smears, compared with 58% in the U.K.

The same is true for mammograms. In the U.S., 84% of women ages 50-64 get them regularly, a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63% of women in the U.K. The high rate of screening in the U.S. reflects access as well as educational efforts by the American Cancer Society and others.

Early diagnosis is important, but survival also depends on getting effective treatment quickly. In the spring of 2007, 58-year-old Valerie Thorpe from Kent, England, went through the anguish of being diagnosed with cancer, and then was told she would have to wait four months before beginning radiation therapy. Her plight was reported in the newspaper because she appealed to her representative in Parliament. But her problem is not unusual. A study by the Royal College of Radiologists, published this June, showed that such waits are typical, and 13% of patients who need radiation never get it due to shortages of equipment and staff.

Long waits for treatment are "common devices used to restrict access to care in countries with universal health insurance," according to a report in Health Affairs (July/August 2007). The British National Health Service has set a target for reducing waits. The goal is that patients will not have to wait more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment.

Access to new, better drugs also explains differences in survival rates. In May, a report in the Annals of Oncology by two Swedish scientists found that cancer patients have the most access to 67 new drugs in France, the U.S., Switzerland and Austria. For example, erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the U.S. than in Europe. One of the report's authors, Dr. Nils Wilking from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the U.S. in the 1990s was due to "the introduction of new oncology drugs," and he urged other countries to make new drugs available faster.

Comments

[annijones]

"...in the U.S. 85% of women ages 25-64 have regular PAP smears, compared with 58% in the U.K.

The same is true for mammograms. In the U.S., 84% of women ages 50-64 get them regularly...."

Your data is old.

http://www.house.gov/weiner/report40.htm

Don't you mean that 66% of women, in the US, who can afford medical insurance, have a mammogram regularly?

I believe the US then falls below the percentiles of the countries with universal health care you mentioned, and far lower than the Dutch and the French!

I am happy to live in a country that guarantees good medical care to all rather than excellence to a few and nothing to many!

Good luck!!

[tomfaranda]

Anni,

Thanks very much for your comment.

Your link to data on Cogressman Weiner's website is interesting - he says his data is from the American Cancer Society , but when you follow his references, the ACS data is different from what he quotes.

The ACS says: "The percentage of women 40 and older who reported having a mammogram in the past 2 years was 76.4% in 2000, but had dropped to 74.6% by 2005. Though small, the decline was statistically significant."

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Mammography_Rates_Inch_Downward.asp

This is much closer to the data presented in my posted article, which you quote above in your comment. And which you then say is "old." Perhaps you should check with Weiner's office as to why he got the data incorrect.

What country do you live in "that guarantees good medical care to all rather than excellence to a few and nothing to many!"? It certainly isn't either the UK or the USA.

For more on the poor care of people with cancer in the United Kingdom here is an editorial from the Wall Street Journal which I quoted, and posted on March 14, '06 stating that only 40% of people in the UK with cancer are seen by an oncologist!

http://tomfaranda.typepad.com/folly/2006/03/health_care_cos.html

In the USA virtually everyone with cancer sees an oncologist. A large portion of this weblog is devoted to talking about cancer, specifically my cancer and I think I have some awareness of this issue.

Perhaps you don't believe the WSJ; here's an article in the Guardian (UK) making the same point, with links to loads of other Guardian articles on the subject.

http://society.guardian.co.uk/cancer/story/0,,450746,00.html

I have a large number of firends and in-laws in the UK, and their anecdotal evidence I think bears out all of the above.

And here's a last link to another of my postings, on progress in treating cancer over the past few years.

http://tomfaranda.typepad.com/folly/2006/02/wall_street_jou.html