Tucked away within the environs of Bart’s, the oldest and most famous of all British hospitals, is the 12th-century church of St Bartholomew the Great, which has served the hospital and surrounding parish since both were founded as part of the priory in 1123. Bart’s survived the dissolution of the monasteries by Henry VIII as the hospital and priory had been separate establishments since 1420.
Later Bart’s escaped the Great Fire of London, although much of its income — derived from property near by — was lost when fire swept through the narrow streets. In its near-900-year history the hospital has contributed to many major advances in medicine, as well as becoming famous for its role in caring for some of the poorest people in London.
As the City has changed in modern times, Bart’s has been able to continue to look after East Enders but is now working in conjunction with the Royal London Hospital.
In the 18th and 19th century Bart’s was the most famous centre of surgery in Britain, and in 1822 it became a formal medical school. In 1850 it was the first medical school to admit a woman and in 1896 the first hospital in Britain to use X-rays. At Bart’s in 1954 the first mega-voltage radiotherapy unit for the treatment of cancer in the UK was established.
Bart’s has never rested on its historical laurels and has recently opened a new breast cancer unit that is comparable to any in the UK and embodies all that is best in 21st-century medicine.
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Once again Bart’s is threatened, not by malevolent monarchs or the flames of the Great Fire, but by a Government as intent on ravaging established institutions as Henry VIII was in destroying the Catholic Church.
Professor Rob Carpenter, a softly spoken Welshman whose manner must reassure any anxious women with newly diagnosed breast cancer, heads the new breast-care unit. Professor Carpenter was speaking in London recently on the latest drug developments that are set to continue the revolution that has altered the outlook in breast cancer care.
Last year the American Cancer Society issued a statement which suggested that if women had regular mammography, as it has urged — so that the cancer is detected when it is still confined to the breast — then the chance of the patient being alive five years later was more than 90 per cent.
The report went on to say that early detection of breast cancer also reduced the need for some forms of drastic treatment, minimised pain and suffering, and allowed women to continue to lead as happy and productive lives as they had done before the diagnosis (one that 60 years earlier would have been so likely to have proved fatal).
Although the value of more frequent, earlier and regular screening into the seventies has been recognised internationally for years, the American standards have not yet been adopted in Britain. While Professor Carpenter spoke about all the latest advances in drug therapy, including Herceptin, which has been regularly in the headlines since last summer, much of his discussion centred on the role of the aromatase inhibitors.
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These three drugs for the hormonal treatment of breast cancer are Arimidex (anastrozole), Femara (letrozole) and Aromasin (exemestane). Each has its own characteristics and so each may, in time, reveal that it is better suited to one patient’s disease than another’s.
These are the drugs likely to replace Tamoxifen, in its time a ground-breaking advance in the treatment of those forms of breast cancer that are oestrogen-receptor positive.
Femara is the latest breast cancer drug to make the news — it is the only aromatase inhibitor, so far, that has been shown to have statistically significant benefits in high-risk women directly after surgery. It had already been granted a licence for first-line treatment for pre-operative use in postmenopausal women.
Femara significantly reduces breast cancer recurrence by 28 per cent in patients who have previously received chemotherapy, and reduces the risk of cancer spreading to other parts of the body by 27 per cent.
Compared with Tamoxifen, Femara improves disease-free survival by 29 per cent when given to high-risk women whose cancer has already spread to lymph nodes.