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The New NICE Guidelines for Management of Breast Cancer—A Personal Commentary
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The new NICE guidelines for management of breast cancer—a personal commentary
Chris Poole, Professor of Medical Oncology, University of Warwick, and Honorary Consultant Medical Oncologist, University Hospital Coventry and Warwickshire NHS Trust
Introduction
The National Institute for Health and Clinical Excellence (NICE), has just issued two more sets of guidelines for oncology specialists, on the management of (i) early-stage and locally advanced, and (ii) advanced breast cancer.1,2 As with each NICE pronouncement, they call to mind the R word—rationing. In this article, I consider how rationing was seen as a force for good at the beginning of World War II, only to be reviled by the public when it persisted beyond 1945, into peacetime. I look at how doctors embraced rationing for its public health qualities as well as its inherent fairness at a time of shortage and national crisis, but how the profession is now conspicuously unimpressed by the pronouncements of our powerful but distinctly nasty ‘rationing institute’. Finally, I ponder some of the less welcome details embedded in the latest NICE verdict on breast cancer.
Discussion.