Hundreds of women are dying needlessly in Switzerland every year because there is no national screening programme for breast cancer.
According to the Swiss Cancer League, 1,300 women in Switzerland still die of the disease every year despite medical progress.
Although the rate of breast cancer is higher in Switzerland than in many other European countries – around 5,000 new cases are diagnosed every year – there is no systematic strategy for detecting the disease in its early stages.
It is left up to the cantons to implement their own policy. Five French-speaking cantons - Vaud, Valais, Geneva, Fribourg and Jura – have joined forces to introduce a standardised early detection scheme.
As a result, they have survival rates significantly higher than in the German-speaking part of the country, the league says.
Oncosuisse, an umbrella organisation of Swiss cancer associations, has called for a systematic national approach to screening.
"If you look at how much we spend on health care in Switzerland – SFr50 billion a year – and consider that the screening programme in the French-speaking part costs a couple of hundred thousand francs, it’s a ridiculous proportion of what’s spent on healthcare overall but still has a considerable impact," Oncosuisse director Reto Obrist told swissinfo.
Switzerland’s federal system – where power is devolved to local and regional authorities – partly explains the lack of a national screening programme.
Although cancer is the second-biggest killer in Switzerland, the Federal Health Office says that setting up nationwide screening would require a new law to be passed.
"The responsibility for healthcare lies with the cantons," spokeswoman Sandra Meier told swissinfo.
The problem, as far as cancer groups are concerned, is that the way the cantons handle this responsibility varies tremendously. The German- and Italian-speaking regions have no systematic breast cancer detection policy.
"It’s not that there’s no screening being done in the German cantons, but that it’s not organised," said Obrist, who is director of the national cancer control programme.
"It depends on the willingness of the doctor to refer the patient for a mammography. It’s therefore not systematic, many women will never get a mammography, it’s not quality controlled, and we do not know what the repercussions will be for breast cancer incidence – we know all this in French-speaking cantons because it’s organised."
Obrist says the different language regions also have different perceptions of the role of the cantonal authorities. Another reason, in his view, for the different approaches is that in German-speaking areas there is more scepticism about the advantages of screening.
He adds that in canton Valais – where there is organised screening – eight women are wrongly diagnosed with breast cancer for every one or two correctly diagnosed cases. "All these women have to go through the diagnostic processes, and undergo biopsy, although in the case of eight of them there is no need."
While cancer groups believe the introduction of a national screening programme is the way forward – and could cut deaths from breast cancer by 30 per cent – they admit that it will be a long, difficult process.
"The federal health system and existing laws in Switzerland make it very difficult to introduce blanket, quality-controlled programmes. Every cantonal mammography programme has a different basis in law and a different funding mechanism," pointed out Stephanie Affolter of the Cancer League.
But in the case of HIV/Aids the Health Office launched a national four-year prevention programme in 2004, and a national anti-tobacco programme has been in place since 2001.
"Aids prevention is one of our main tasks, and we have a law for that. We don’t have a law that says that the Federal Health Office has to be active in cancer programmes," Meier said.
Another problem is that cuts in federal funding are limiting the office’s scope for action. "We need a budget and resources," commented Meier.
Obrist of Oncosuisse said it was widely accepted that the Health Office needed to have guaranteed funds to introduce an early detection scheme for breast cancer nationwide.
"If they have to finance it from their own budget it’s almost impossible. And in these times when everyone is trying to save money you can imagine how willing they are to venture into this."
Obrist and Meier said discussions were taking place among the different cancer associations, the cantons and health officials to try to move the process forward. One of the aims was to reach agreement across the cantons on harmonising the different detection programmes.
Cancer groups were also pressing members of parliament to pass a law that would authorise the Health Office to introduce systematic screening.
Meier told swissinfo the Health Office was "eager" to make progress in screening and early detection, but Obrist cautioned that it would probably be years before a national programme was in place.
"In Switzerland, it takes about ten years to push a new law through parliament," he said.
"Perhaps in 2015 we will have a law which is formulated in such a way that screening might be possible."
swissinfo, Morven McLean
The Swiss Cancer League estimates that up to 5,000 new cases of breast cancer are diagnosed every year in Switzerland.
One in ten women in Switzerland develop the disease.
There are around 1,300 breast cancer deaths a year.
Thanks to modern treatment methods 70% of women are still alive five years after being diagnosed.
In 1994 the WHO called for national programmes against cancer.
In 2002 the European Parliament called on member states to offer mammograms at two-year intervals to all women aged 50-69.
To date, eight EU countries have fully implemented national breast screening programmes following European guidelines: Belgium, Finland, France, Hungary, Luxembourg, the Netherlands, Sweden and Britain.
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