Breast Cancer, 1971-91

Twenty years ago, President Nixon launched the "war on cancer" with the signing of the National Cancer Act. This report reviews progress in prevention and treatment of breast cancer over the past two decades and determines what kinds of research are needed to help prevent breast cancer and improve survival rates. GAO concludes that while many breast cancer patients are living longer and their quality of life has improved, the struggle against the "dread disease" has not been won. The expectation is that the coming year will see more women stricken with the disease and more women dying from it than two decades ago. On the positive side, medical detection, diagnosis, and treatment of breast cancer have improved because of widespread availability of technologies like mammography. In addition, breast cancer surgery has been refined, with the Halstead, or radical mastectomy--and its disfiguring results--becoming much rarer. In examining breast cancer research, GAO concludes that gaps in fundamental knowledge about the etiology of breast cancer (causes and their mode of operation) are the critical obstacles to more effective detection, diagnosis, and treatment. Further, identifying chains of events leading to the onset of breast cancer and learning how to interrupt those sequences are the primary prerequisites for preventive measures. GAO summarized this report in testimony before Congress; see: Breast Cancer: Progress to Data and Directions for the Future, by Richard L. Linster, Director for Planning and Reporting in the Program Evaluation and Methodology Division, before the Subcommittee on Human Resources and Intergovernmental Affairs, House Committee on Government Operations. GAO/T-PEMD-92-4, Dec. 11, 1991 (six pages).

GAO found that: (1) the number of American women diagnosed with breast cancer increases each year, between fiscal year (FY) 1973 and FY 1988 the estimated number of new cases of breast cancer diagnosed grew from 73,000 to 135,000; (2) although more and more women are dying from breast cancer, the adjusted mortality rate has remained relatively constant since FY 1973; (3) the detection, diagnosis, and treatment of breast cancer has improved, since the availability of mammography; (4) based on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, the average size of breast cancer tumors steadily decreased between FY 1977 and FY 1987; (5) the 5-year survival rate for breast cancer patients diagnosed during the period between FY 1981 and FY 1983 was 77 percent, whereas 74.1 percent of the patients diagnosed during the period between FY 1974 and FY 1976 period survived for at least 5 years; (6) although there has been little in the way of facts, evidence, or hard data to support what can be done to improve breast cancer survival rates, a breast cancer patient today has a higher probability of 5-year survival than a patient 20 years ago; (7) it is unlikely that prevention efforts will reduce the incidence of breast cancer, since such identified risk factors as age and heredity can not be changed; and (8) research expenditures for breast cancer are equivalent to or greater than expenditures for other selected conditions.