European Breast Cancer Conference, Vienna, March 2012
Need for updated breast cancer guidelines and screening programs
Professor Marco Rosselli del Turco – President of the European Society of Breast Cancer Specialists (EUSOMA)
Professor Rosselli del Turco, which is a long name but a very important, a very ancient combination of two Italian family names, welcome and thank you for speaking to ecancer.
You have dedicated a lot of your time as a senologist working on improving outcomes, improving guidelines for screening and for treatment and so on, it’s a real passion with you, isn’t it?
Yes it is. I started as a breast radiologist and at that time, when the screening was developing, because we had the first experience in Florence in the 1980s, it was the first European breast cancer screening, population based, so we have worked a lot on improving quality in screening. After that I moved a little bit more to cancer prevention in general and the last year set to improving quality of care.
And you are the past President of EUSOMA?
Yes, I am the past President of the European Society of Breast Specialists, which is EUSOMA.
And now you’re looking at improving quality further afield; what are you doing and how are you doing that?
Yes, we are working, EUSOMA have a large project, one of the aims of this society is to improve the quality of care in Europe in general. We are trying to develop some means, some tools, to measure the quality of care and to try to help the units to improve their quality. I think this project has already been quite successful, we already have something like thirty units in Europe which have been certified by EUSOMA as good units which are compliant with the indicators that we have selected. But it is anyhow a developing work and we have to update the quality indicators, we have to measure them and probably in the future become more and more severe because passing the time we want to expect a better quality.
I remember you and I discussing guidelines two or three years ago in an FP7 project and the desire of patients to be involved in discussing guidelines. Is that something that you still have a view on?
Yes, in general EUSOMA, all the work it is doing is doing in partnership with also the patient association, with Europa Donna, so we are taking account of this. It’s not difficult, it’s easy work because the point of view can be different but I think it is important that somehow that the clinical professionals, they pay attention also to what the women require. We are trying to use this also for the certification process of the breast units, we are taking into serious consideration if these units are not providing a good care but also care in terms of information to the woman and patient support.
And do you get feedback from patients or is that left to each institute to do?
We don’t have, let’s say, a systematic survey of what is the feedback for the patient at each institution.
On its own?
Now, in the screening debate today we heard some really interesting discussions about whether breast cancer screening improves mortality rates or not. Where are you sitting on that in Florence?
We think that there is good evidence that screen decreases mortality. Nowadays we know that women may also attend a spontaneous screening so also in some countries in the absence of organised screening they may have some benefit from early detection anyhow, but I think this would be less cost-effective and so we are still thinking that a well-organised centralised programme is the best solution from a public health point of view. We think that the controversy is because the methodology in analysing the data is completely different and I’m sure that after this big debate, which is anyhow important, which helps us to better understand what is the effect of what we are doing, I’m sure that we will come to some kind of consensus that screening is effective, maybe with a little bit lower level than what we thought before.
Yes, Richard Peto says 5 per 2,000, would you be in that sort of area?
Yes, it could be, yes.
That seems to me to be quite an important gain which is certainly better than anything else in the screening world, except in, say, hypertension or diabetes or something like that. So it seems to me that it’s good evidence but, as you say, the debate will go on for some time to come and only when we get the analysis of all nine randomised trials, which Peto was planning to do over the next two years.
Yes, I think that it is important to review the old trials but also it is important that the groups which are fighting against two different points of view speak together and try to discuss which methods they use. Because now we are in a situation where one group says something and is published by himself, another group says something else, but they don’t want to discuss together. This is not good because in science normally you have to be open to any kind of criticism and discussion but if they would discuss the methodological aspects I’m sure they could come to a consensus.
Good, thank you very much indeed. I really appreciate it.
It was nice to be here.