Significant numbers of women may have been put at risk of their breast cancer returning because they were not given the best care at a hospital in the Bradford NHS Trust, according to a cancer statistician.
The claims, based on a data analysis by Michel Coleman, professor of epidemiology at the London School of Hygiene and Tropical Medicine,are disputed by the trust. Professor Coleman found that women under the care of a particular surgical team were far less likely to be referred for radiotherapy to kill off remaining cancer cells after an operation to remove the tumour. Around 150 women who would have been expected to receive radiotherapy did not get it, he says, mostly in the 10 years from 1988 to 1998.
Prof Coleman's allegations will be broadcast as part of a BBC Panorama investigation tomorrow night.
The trust acknowledges that there was a lower than average rate of referral for radiotherapy between 1982 and 1994 and that referral rates were still low from 1995 onwards.
It says that the surgeon responsible for the team had concerns over the side-effects of radiotherapy. But the trust contests Professor Coleman's additional finding that the lack of radiotherapy may have been linked to a higher death rate among the patients of the surgical team.
Prof Coleman's analysis of data from the Yorkshire Cancer Registry between 1982 and 2003 suggests that there were 30 to 40 more deaths than would have been expected among the patients of the surgical team. The report was commissioned by Panorama after allegations from John Philip, former director of the regional breast screening programme, that women who had breast conservation surgery - the removal of the lump instead of the whole breast - were coming back with a recurrence of their cancer because they had not been given radiotherapy. Michael Baum, professor emeritus of surgery at University College London, tells the programme that if radiotherapy does not follow surgery, there is around a 30% chance of the cancer returning.
Prof Coleman found that between 1982 and 2003, 46% of the patients of one surgeon were given radiotherapy, compared with 84% of the patients in other hospitals in Yorkshire.
A battle between the programme makers and the trust has been fought since Prof Coleman's report was completed, culminating in a letter published online by the Lancet yesterday from Bradford's medical director, John Wright, and colleagues including two independent statistical experts. They accuse Panorama of failing to discuss the issues with them and express concern that the programme will unfairly pillory a single surgeon.
"The case has major implications about the use and misuse of routinely collected data to publicly accuse doctors of harming patients," they write. They were anxious about the possible misinterpretation of data. "In the hands of media that cannot appreciate the subtlety, complexity and uncertainty surrounding these data, there is a danger that performance figures will be misunderstood or even misused."
But Panorama claims that Bradford's only interest has been in getting the programme stopped.
Both sides have brought in expert statisticians to look again at Prof Coleman's work. Bradford employed Professor Trevor Sheldon from York University, who said the analysis was flawed and the increased death rate could have been down to chance, case mix or selection bias.
Panorama called in David Spiegelhalter, who was an expert adviser to the Shipman inquiry and investigated the high death rates of babies in heart surgery at Bristol Royal Infirmary in the 1990s. Dr Spiegelhalter backed Prof Coleman's analysis, although he was cautious about the numbers of excess deaths.
The clash of experts illustrates the difficulty for the public of exercising the "patient choice" the government says it wants them to have.
Hospitals do not routinely collect data on the success rates of doctors. In this case the only data available had been collected from the screening programme and, for research purposes, by the Yorkshire Cancer Registry.
Prof Coleman told the Guardian hospitals were unlikely to collect sufficient good quality data on a voluntary basis. "Until data collection of this kind is not just a requirement but a statutory requirement, it will not happen."
Dr Wright said that the trust had carried out an internal patient audit to establish how many women had a recurrence of their cancer after breast conservation surgery. It appeared to show that recurrence rates were low.
The audit did not include patients before 1995, however. "This is a very busy hospital and doing this kind of audit is very time-consuming," he said.
Panorama has established helplines for women in Bradford who are concerned by the programme's findings, provided by the charities Breakthrough Breast Cancer and Breast Cancer Care.
The number, available after the broadcast, is 08080 100 200.
