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Late cancer diagnosis 'costing lives and money' PDF Print E-mail

"Almost half of cancer patients diagnosed too late," says The Guardian, citing a new report that explored both the financial and health impact of late cancer diagnosis.

The late diagnosis of almost all types of cancer usually means the disease has already spread within the body, making it less treatable, reducing a patient's chances of survival, and potentially increasing the cost of effective treatments.

This means an enduring aim of cancer treatment is to pick up the disease as soon as possible, so treatment is more likely to be effective.

The report predicted around 52,000 cases of four common cancers (colon, rectal, lung and ovarian) may be spotted too late every year, costing the NHS around an extra £150 million to treat.

Various theories have been put forward to explain why this is the case, including "patients put[ting] their heads in the sand when they feared cancer", and how "doctors are struggling to get patients seen quickly".


Who produced this report on late cancer diagnoses?

The report was produced by Incisive Health, a specialist health policy and communications consultancy, in collaboration with experts at Cancer Research UK, a leading cancer charity. It was funded by Cancer Research UK.

The report – titled "Saving lives, averting costs: an analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer" – presumed that early diagnosis is crucial, and aimed to uncover the financial implications of achieving earlier diagnosis for colon, rectal, non-small cell lung (the most common type of lung cancer) and ovarian cancers.

The report estimated the number of people currently diagnosed with cancer using national guidance and data sources. This included data on the stage of the cancer when it was diagnosed (where available), and the authors calculated the cost of treatment. They then modelled what would happen if the cancers had been diagnosed earlier.


Links To The Headlines

Almost half of cancer patients diagnosed too late. The Guardian, September 22 2014

50,000 lives cut short by cancer diagnosis failings. The Daily Telegraph, September 22 2014

52,000 cancer cases a year are spotted too late: Delays blamed on 'stiff upper lip' mentality and pressure on GPs not to refer patents for costly tests. Mail Online, September 22 2014

Almost half of cancers 'caught too late'. ITV News, September 22 2014

Links To Science

Cancer Research UK. Half of cancers diagnosed at late stage as report shows early diagnosis saves lives and could save the NHS money. September 22 2014

Family Squabbles Can Derail Recovery From Cancer Surgery PDF Print E-mail
Title: Family Squabbles Can Derail Recovery From Cancer Surgery
Category: Health News
Created: 9/18/2014 7:36:00 PM
Last Editorial Review: 9/19/2014 12:00:00 AM
Mums 'feel shame' about how they feed their babies PDF Print E-mail

"Mothers are made to feel 'marginalised and ashamed' when they breastfeed in public, according to an international study," the Mail Online reports. But the same study found mothers who bottlefeed also feel subject to criticism.

The study used discussion groups and interviews to explore the thoughts, feelings and experiences – as well as perceived barriers and facilitators – of feeding infants among a small sample of mothers in north-west England.

A common theme was the shame felt by both mothers who breastfeed and bottlefeed their babies. For example, some breastfeeding mothers discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby often feel frowned upon for not breastfeeding.

This was a small study involving just 63 women in one region of England, so we cannot assume its findings are representative of other, larger populations. But it does provide a useful insight into how, for some women, breastfeeding has become an emotional minefield. It suggests there is an important psychological, not just physical, aspect to breastfeeding.

The researchers conclude that health professionals need to find effective methods of providing support to combat feelings of shame in mothers who either breast or bottlefeed.


Where did the story come from?

The study was carried out by researchers from the University of Central Lancashire in England, the Georg Eckert Institute for International Textbook Research in Germany, and Dalarna University in Sweden.

Funding was provided by the North Lancashire Primary Care Trust.

It was published in the peer-reviewed medical journal Maternal and Child Nutrition on an open-access basis, so it can be read online for free.

The Mail Online is generally representative of this research, making it clear these findings are from only 63 women.

However, the headline and general tone of its article mainly focuses on the shame that may be felt on breastfeeding in public. The experience of women who do not breastfeed is largely ignored.


What kind of research was this?

This was a qualitative study that aimed to review women's experiences, thoughts and feelings related to feeding their baby. Qualitative research uses methods such as interviews, observations and discussion groups to understand people's views and feelings, and what motivates them.

The researchers state that emotions such as guilt and blame are often reported among mothers who do not breastfeed, while those who do breastfeed can sometimes feel fear and humiliation when feeding in public places.

In this study, a sample of breastfeeding women and those who did not breastfeed (taken from two primary care trusts in north-west England) took part in discussion groups and individual interviews to explore their experiences, opinions and perceptions of feeding their baby.


What did the research involve?

This study reflects information as part of a wider UNICEF UK Baby Friendly Initiative community project in two community health facilities in north-west England.

A total of 63 women were recruited from various mother and baby groups or clinics (such as baby massage, mother and baby groups, and breastfeeding groups). The researchers report they took care to include women representative of low to high socioeconomic status by recruiting them from a range of different backgrounds.

The mothers' average age was 30 years, most were white British, and most were married or cohabiting and had one or two children. Their infants were mostly aged between 4 and 24 weeks, though 11 infants were aged 6 to 12 months, and 10 were over the age of 1.

Of the women recruited, 28 were breastfeeding, 11 were formula feeding, 7 were mixed feeding through breast and formula, and the remainder were feeding a combination of complementary foods with either breast or formula.

Thirty-three of the women took part in 7 discussion groups (focus groups), and 30 women received individual interviews in their homes, though 2 sets of women were interviewed in pairs.

In both settings, women were asked a range of questions designed to explore the women's current infant feeding status, intentions and motivations behind the feeding pattern, and barriers and facilitators to support. For example, among other questions, the researchers asked:

  • Why did you choose to breastfeed or formula feed your baby?
  • What information did you receive in regard to infant feeding (antenatally and postnatally)?
  • Did any professionals discuss (or provide demonstrations) on infant feeding (breastfeeding or formula feeding)?

The interviews and focus groups took between 25 and 80 minutes to complete, and were digitally recorded and transcribed in full.


What were the basic results?

The researchers explain how many of the women's discussions about their infant feeding experience involved feelings of shame, frequently indicating a sense of feeling out of control and a dependence on others because of insufficient information and a lack of appropriate infant feeding support.

They also say that when a mother's infant feeding method was not as she (or others) intended, this could lead to further feelings of incompetence, inadequacy and inferiority.

The researchers discuss the concept of how both bottle and breastfeeding can both be a source of "offence" to others in different ways.

They also discuss how some of the discussions revealed how women sometimes held ideals and expectations of being a "good" mother. Some women felt anxious, fearful and dependent as a result of various influences: the experience of birth, being overwhelmed by new motherhood and not feeling prepared, cultural influences, and infant feeding.

These feelings were particularly common among first-time mothers, who often weren't aware of what support they would need until faced with the realities of motherhood. Many referred to how they felt expected or under pressure to breastfeed, a pressure transmitted by cultural messages as well as health professionals. Women were said to often experience this as an additional burden of the already bewildering state of new motherhood.

When exploring the social context of any feelings of shame that were experienced by breastfeeding women, a common theme that emerged was related to exposing their breasts in public and concerns about what people thought, or being stared at or frowned upon.

Similar feelings of shame and judgement were reported by women who don't breastfeed their babies, such as people judging them for not breastfeeding. Some women also reported feeling a lack of confidence or difficulties in asking professionals for support about feeding.   


How did the researchers interpret the results?

The researchers say how their paper "highlights how breastfeeding and non-breastfeeding women may experience judgement and condemnation in interactions with health professionals as well as within community contexts, leading to feelings of failure, inadequacy and isolation".

They say there is a "need for strategies and support that address personal, cultural, ideological and structural constraints of infant feeding".



This informative study explores the attitudes and experiences surrounding infant feeding, as well as the perceived barriers and ways this could be changed, looking at a sample of mothers in north-west England.

A common theme revealed by mothers related to public and professional perceptions and expectations around infant feeding practices. Both breastfeeding and non-breastfeeding women discussed a sense of shame around their feeding practice for different reasons.

For example, some breastfeeding women discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby can feel frowned upon for not breastfeeding. Another common theme discussed by mothers related to feelings of difficulties in accessing support.

This study has provided new insights into the factors that may induce shame in new mothers. Qualitative research of this nature aims to give a detailed exploration of people's views and experiences, and all data and quotes were carefully collected and analysed.

But because of the depth of the analysis, the sample size in these studies tends to be quite small. This study therefore reflects the experiences of only 63 women in one region of England. With only four mothers from minority ethnic groups, it is not known how representative these experiences are of other cultural groups.

Women should never feel ashamed of breastfeeding in public. If other people take issue with it, it is their problem, not yours.

On the other hand, women who find it just too difficult to breastfeed, or can't for other reasons, should also not feel ashamed or guilty.

While breastfeeding does bring proven health benefits to a baby, having a happy and confident mother is probably as, if not more, important. 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Breastfeeding in public 'still frowned upon': Mothers made to feel 'marginalised and ashamed', study finds. Mail Online, September 18 2014

Links To Science

Thomson G, Ebisch-Burton K, Flacking R. Shame if you do – shame if you don't: women's experiences of infant feeding. Maternal and Child Nutrition. Published online August 19 2014

'Angelina Jolie effect' doubled breast gene tests PDF Print E-mail

“Referrals to breast cancer clinics more than doubled in the UK after Angelina Jolie announced she had had a double mastectomy,” BBC News reports. NHS services saw a sharp rise in referrals from women worried about their family history of breast cancer.

In May 2013, actress Angelina Jolie announced that she had decided to undergo a double mastectomy followed by breast reconstruction surgery, as gene testing estimated she had an 87% chance of developing breast cancer.

Examination of trends in genetic testing clinics in the UK showed that there was a peak in referral rates in June and July, with numbers standing at around two-and-half times higher than the previous year. There was almost a doubling in requests for predictive genetic tests for cancer risk genes, and many more enquiries about preventative mastectomy. Researchers were also encouraged by finding that all referrals to genetic or family history clinics were appropriate (that the so-called “worried well” weren’t diverting resources from where they were needed).

This study can’t prove a direct cause and effect, but the evidence seems compelling.

The researchers also speculate that, as Angelina Jolie is seen as a glamorous icon, her decision may have reassured women who fear that preventative surgery would make a woman less attractive.

The actress would have been well within her rights to keep her health confidential, particularly knowing the media interest it would create. Her decision to speak out and help destigmatise mastectomies should be congratulated.


Where did the story come from?

The study was carried out by researchers from the University Hospital of South Manchester NHS Trust, and the Manchester Centre for Genomic Medicine at St. Mary’s Hospital. Financial support was provided by the Genesis Breast Cancer Prevention Appeal and Breast Cancer Campaign.

The study was published in the peer-reviewed medical journal Breast Cancer Research on an open-access basis, so it is free to read online.

The UK media’s reporting was generally accurate, though the Daily Mirror got a little confused with its headline "'Angelina Jolie effect' credited for huge rise in double mastectomies to reduce breast cancer risk”.

The effect did cause a rise in the number of women being tested to see if a double mastectomy was required. However, the research didn't look at the number of operations carried out. As most of the tests would have actually proved negative, the impact on the number of operations is unlikely to have been a “huge rise”.


What kind of research was this?

This was a review of breast cancer-related referrals to family history clinics and genetics services within the UK for 2012 and 2013, to see how the trends changed between the two years.

As the researchers discuss, it is common for news items related to a particular health service to lead to a short-term temporary increase in interest. There is rarely a long-lasting effect once the media attention has died down. For example, the 2009 death of reality TV star Jade Goody from cervical cancer led to a shortlived increase in the number of young women attending cervical cancer screening appointments.

In 2013, there was said to be “unprecedented publicity of hereditary breast cancer” in the UK. This was associated with two things. First came the release of draft guidance from the National Institute of Health and Care Excellence (NICE) on familial (hereditary) breast cancer in January, followed by the final publication in June 2013. Second, and seemingly more significant, was the high-profile news reports that broke in May 2013 of actress Angelina Jolie’s decision to undergo a double mastectomy when finding that she had inherited the BRCA1 gene – putting her at high risk of developing breast cancer.

Studies suggested that the news stories were associated with increases in attendance at hereditary breast cancer clinics and genetics services in the US, Canada, Australia, New Zealand and the UK. This study assessed the potential effects of the “Angelina Jolie effect” by looking at UK referrals due to breast cancer family history in the UK for the year 2012 compared to 2013.


What did the research involve?

This research looked at referrals specific to breast cancer for 21 centres in the UK. This included 12 of 34 family history clinics invited to participate, and nine of 19 regional genetics centres. Centres that did not supply data were reported to either not have this available, or were unable to collate the data. Monthly referrals to each centre for 2012 and 2013 were assessed, and the trends analysed. 


What were the basic results?

The results show that overall referral rates were 17% higher in the period January to April 2013 than they had been in the previous year (the draft NICE guidance on familial breast cancer hit the media in January 2013, prior to final publication in June). However, there was nearly a 50% rise in May 2013, which was too early to have been associated with the final publication of NICE guidance, and coincided with the media reports about Angelina Jolie.

In June and July 2013, referral rates to the clinics were 4,847 – two-and-a-half times as many as in the same period the previous year (1,981 in 2012). From August to October, they were around twice as high as they had been in the same period the previous year. The referral rates then settled down again to being 32% higher in November and December 2013 than in November and December 2012.

In total, referrals rose from 12,142 in 2012 to 19,751 in 2013. There was almost a doubling in requests for BRCA1/2 testing, and many more enquiries about preventative mastectomies.

Encouragingly, internal reviews from specific centres show that there was no increase in inappropriate referrals.


How did the researchers interpret the results?

The researchers conclude that, “the Angelina Jolie effect has been long-lasting and global, and appears to have increased referrals to centres appropriately”.



This is an interesting study that reviewed how the trends in breast cancer-related referrals to breast cancer family history clinics and genetics centres in the UK changed between 2012 and 2013. The overall results show an increase in 2013, with particular peaks following high-profile media events – most notably, news of Angelina Jolie’s decision to have a double mastectomy in May of that year.

However, there are a couple of points to bear in mind when interpreting these results.

Firstly, the study did not have data available from all family history clinics and genetics centres in the UK, and the results are only representative of 40% of those who would have been eligible to participate. Therefore, it is not known whether the trends would be the same were data available from all services. However, this is a good representation, so is likely to give a good indicator.

Studies such as this can assess trends, but it is still not possible to know the direct cause of any changes. As this study says, there were two related events that received media attention in 2013: the publication of NICE guidance on familial breast cancer (pre-publication in January and final publication in June); and the higher-profile news reports in May of Angelina Jolie’s decision to have a double mastectomy due to her high risk of developing familial breast cancer.

While it may be plausible that the rises in referral rates to family history and genetics clinics were associated with this increased media attention, particularly the “Angelina effect”, it still cannot be proven that this is the only cause. Alternatively, the increase in trend could also be related to a gradual year-on-year increase in people’s health awareness.       

It would be interesting to see how trends changed in years prior to 2012. It would also be interesting to know what has happened to the trend in referral rates through 2014. 

Overall, the particular peaks in referral rates in June and July 2013 suggest that the news related to Angelina Jolie, perhaps combined with the publication of NICE guidance on familial breast cancer testing around this time, have a high chance of being associated with the increased referral rates.

This is not surprising given the thought-provoking influence that the media is known to have.

It is also encouraging to know that all referrals to genetic or family history clinics were appropriate, suggesting that the media attention is likely to have had a positive effect in increasing health awareness.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Breast cancer test 'Angelina Jolie effect' found. BBC News, September 19 2014

The Angelina effect: Surge in women going for breast cancer checks after actress speaks out about her mastectomy. Daily Mail, September 19 2014

The 'Angelina Jolie effect': Her mastectomy revelation doubled NHS breast cancer testing referrals. The Independent, September 19 2014

Angelina Jolie's breast cancer announcement doubled number of women being tested: study. The Daily Telegraph, September 19 2014

'Angelina Jolie effect' credited for huge rise in double mastectomies to reduce breast cancer risk. Daily Mirror, September 19 2014

Angelina Jolie's op sparks huge surge in the number of cancer tests. Daily Express, September 19 2014

Links To Science

Evans DGR, Barwell J, Eccles DM, et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Research. Published online September 19 2014

DNA Blood Test Might Identify Status of Prostate Cancer PDF Print E-mail
Title: DNA Blood Test Might Identify Status of Prostate Cancer
Category: Health News
Created: 9/17/2014 4:37:00 PM
Last Editorial Review: 9/18/2014 12:00:00 AM
Cancer test 'Jolie effect' found PDF Print E-mail
Referrals to breast cancer clinics more than doubled in the UK after Angelina Jolie revealed last year she had had a double mastectomy, say scientists.
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