Prostate cancer screening must be rolled out nationally, Rishi Sunak has urged.
Haven’t we all been through this before? And it was found that as 50% of men will die with it and only 8% (or whatever) of it then and therefore screeing up to about 70 seems sensible, after that why worry everyone?
Now, that might be mixing in a bit of the American experience. But population health isn’t all that different.
Last time I looked the argument against prostate screening looked pretty sound. Ditto breast screening. Even cervical screening looked pretty marginal.
It’s the “mass” nature of the screening that is the weakness – if they called in only people who might be at disproportionate risk that would presumably be different.
Who might be at disproportionate risk? Dunno: how about looking at family medical record, nature of career, obesity, even local sunniness, water etc? You know, stuff a serious epidemiologist might wonder about rather than headline-seeking hysterics who pass themselves off as epidemiologists.
There is a tv ‘advert’ recommending prostate cancer screening, stating the percentages of men susceptible to it. Some numpties are claiming that those figures are racist as black men are said to have a higher percentage than white men (genetics, anyone?).
On a personal note, a routine blood test, at 74 years old, then a biopsy, revealed my stage 4 prostate cancer, and the subsequent treatment has enabled me to live a little bit longer, to see my grandchildren grow some more, so screening after 70 is still important, in my opinion.
“so screening after 70 is still important, in my opinion.”
(i) But you weren’t “screened” you had a routine blood test.
(ii) No argument for screening makes sense if it doesn’t compare costs and benefits.
I think that it’s far higher than 50% of men dying with prostate cancer (rather than from it)… According to my consultant, when I was diagnosed with it some 20 years ago, nearly every man who dies over the age of 75 will have some traces of it.
PSA is a notoriously imprecise indicator of prostate cancer. To get even close to reasonable measurement you have to abstain from sex and bike riding for 48 hours and vigorous exercise for 24 hours.
The next stage of an MRI scan is expensive and requires the use of a scarce resource. When I was called in for 2 scans I was warned that there may be higher priority patients brought in ahead of me. A full plate biopsy is invasive and can have severe and permanent side effects such as impotence and incontinence.
Those are not procedures that should be carried out “just in case”.
That said, PSA can be useful if you have a baseline. Every time I had a blood test from the age of about 40 I asked for a PSA test. That meant when I did get a high reading the doctor knew it could be a sign or problems, even so he did a 2nd test a week later to confirm.
Young men should be encouraged to get a regular PSA test to get a baseline. They cost about £100 when don’t privately so once a year isn’t going to break the bank. Those who care would be more than happy if informed about how to go about it and those who don’t care probably wouldn’t turn up for screening anyway.
Probably, screening for disease makes sense in a ‘socialised’ health system. But then ‘socialised’ healthcare has failed.
And another thing: the risk factors for prostate cancer are legion…
“the risk factors for prostate cancer are legion”
‘Risk factor’ means positive correlate. To find out whether any have causative effects you have to do research. Proper research, not “look at me” research. It might be better the spend some of the money on that rather than ineffective screening.
Or it might be that mountains of money have already been spent on futile research. If so abandon the favoured lines of enquiry.
Aha, our blogger simplified a bit. “Mr Sunak calls for targeted screening, so those with higher risk of the disease such as those with a family history of it undergo checks.” Sensible lad.
I would have thought that a simple PSA test conducted regularly would be a pretty cheap way to screen and provide an early warning, because not all Prostate cancer is particularly benign and slow to progress. PSA is not exact, but a trend over a reasonable time is a pretty good indicator. That does require testing on a regular basis, say once a year or sofa, say 5-8 years to establish a baseline. And the tests are pretty automated these days.