Inequalities in breast cancer care and outcome.

Comparisons across Europe suggest that survival from breast cancer is less good in the United Kingdom than in many countries. The care given in some UK breast cancer units is exemplary. However, it is difficult to escape the conclusion that a substantial number of women who present with breast cancer receive suboptimal care. Cancer registry-based studies have clearly demonstrated variations between surgeons and between hospitals in the management of early breast cancer. Although variations in surgical practice per se may have little impact on survival, there is evidence that differences in the use of systemic adjuvant therapy influence outcome. Five-year survival seems to be greater in women treated by surgeons seeing more than 30-50 new cases of breast cancer each year. This may be because such patients are more likely to be treated by a multidisciplinary team and to receive adjuvant therapy. Proposals that would increase the overall quality of breast cancer care and remove current inequalities must be carefully considered and should then be implemented.