Abstract
Bosanquet and Sikora 1 are rightly concerned about the cancer reform strategy, and I share their concerns, but to portray cancer as a chronic disease does not do justice to cancer survivors. Many of these are not living with active cancer, but with the adverse events caused by cancer treatment, some of them progressive (for instance, radiation damage), and their needs also should be met. 2
However, I am just as shocked as the authors in noting the extremely unambitious target of 62 days from referral to treatment, which has been recently reiterated in Scotland. 3 The geography of Scotland, with its widely dispersed population as well as pockets of severe social deprivation, adds to the challenges faced by the NHS. But I fail to understand how the situation has actually deteriorated in the last 20 years – at least for breast cancer. In 1986 it took a mere fortnight from my GP referral to surgery in my local hospital in West Sussex.
Perhaps the present problems of tardy treatment could be attributed partly to increased incidence, but lifestyle, HRT, oral contraceptives and night-shift working cannot be the only reasons for this, since other hormonal cancers such as those of the testis and prostate are also on the increase. I suggest that we need to look at environmental factors, particularly endocrine disrupters in plastics, pesticides, et cetera. When fish change sex in rivers and men's sperm count declines, we have to consider the wider picture. 4 The workplace too can still be horrifyingly carcinogenic, and affects particularly blue-collar workers. 5 We must look urgently at primary prevention as well as treatment.
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