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Scots Cancer Patients Receive Drug Denied South of Border

Posted on: Friday, 17 February 2006, 06:00 CST

By Louise Gray

A BREAKTHROUGH cancer drug which was controversially denied to women in England is being routinely prescribed in Scotland, The Scotsman has discovered.

More than 30 women with early-stage breast cancer have been given Herceptin in Scotland even though the drug has not been given formal approval by the national UK licensing body.

Studies have shown the drug can halve the risk of the cancer returning. However, at a cost of about GBP 20,000 per patient per year, it is an expensive choice.

In England and Wales, officials have refused to give it to patients. Earlier this week a High Court judge supported an English Primary Care Trust in refusing to give Ann Marie Rogers the drug. Meanwhile Cardiff mother Jayne Sullivan has camped for a week at the Welsh Assembly to voice protest.

Yet a Scotsman investigation has found that eight out of the 15 health boards in Scotland are prescribing Herceptin to women with early breast cancer. The other boards had either not given the drug or were unable to respond to our questionnaire.

Charities last night welcomed the Scottish move, but hit out at the "postcode lottery" that is emerging across the UK.

Every year about 3,500 women are diagnosed with breast cancer in Scotland and about 1,000 women die. About 700 of the breast cancer sufferers are thought to have a gene called HER 2 and it is this group of women who stand to benefit. US studies have shown women with breast cancer who are HER 2-positive can halve the risk a tumour reoccuring if the disease is treated early.

Yet in the UK, Herceptin has only been licensed for the treatment of advanced breast cancer. It is not expected to gain a licence for early stages until the end of the year. Only then will it be looked at by the National Institute for Clinical Excellence (NICE) in England and Wales and the Scottish Medicines Consortium in Scotland to see if it is cost effective enough to be used on the NHS.

But The Scotsman has established that Scottish health boards have already started offering the drug.

Between October and December last year, NHS Greater Glasgow prescribed Herceptin to 24 early breast cancer patients. These include those referred to Glasgow from the four other west Scotland health boards - Argyll and Clyde, Lanarkshire, Ayrshire and Arran, and Dumfries and Galloway.

NHS Grampian is giving six women Herceptin, a spokesman said.

NHS Western Isles has given one patient the drug and NHS Lothian is prescribing it to a "small number" of early breast cancer patients.

Wider prescribing of the drug has huge implications for Scotland's drugs budget. The cancer drugs bill is rising at about 30 per cent each year and it is estimated it could go up by GBP 10 million if Herceptin is approved for early breast cancer.

Since Herceptin has not been licensed there are also safety issues: side-effects found included the risk of heart problems.

NHS Tayside, which has agreed to prescribe Herceptin in "exceptional circumstances" but has so far not approved any cases, said the drug would only be recommended to patients where the benefits outweighed the risks.

Dr John Dewar, the head of medical oncology at Ninewells Hospital in Dundee, said: "The only circumstances where we would wish to consider using it would be in those patients who have a relatively high risk of the breast cancer relapsing. For these, it is reasonable to say yes. There are hazards in giving out an unlicensed drug, but they are counter-balanced by the high risk of the cancer."

However, he added: "It is a difficult business to try to balance quite correctly. There is a pot of money and if you spend it on one thing you cannot spend it on another."

However, charities said money should not be a factor in a life and death situation.

Jenny Whelan, head of CancerBACUP Scotland, said: "We have postcode prescribing of this cancer treatment throughout the UK and that is unacceptable. People want to know that decisions depend on clinical need and not on where they live, how much money they have, or how 'exceptional' they are."

A spokesman for Breast Cancer Care added: "Treatment decisions should be made on clinical benefit alone and not on financial or geographical considerations."

Source: Scotsman, The

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