Is mandatory screening a good thing?

This post was prompted by the recent headline, written after several years of research, showing that up to 4000 women per year are being over diagnosed, for breast cancer.This is something that I have always suspected would be the case, and I can see arguments both for and against.

There have also been calls for routine PSA ( Prostate Specific Antigen ) tests for men over the age of 50, as an early detection of prostate cancer. However, after many years of research, there still is no definitive answer as to whether, this is the right way to go forward.

There are several different views in this discussion. Firstly, the obvious one, is anything that saves lives is worthwhile! Secondly, in today’s economic climate, the total cost of screening millions of people.Finally, the emotional cost on ‘the worried well’.

According to the recent statistics, routine mammograms save approximately 1300 lives per year.But for every life saved, 3 people are over diagnosed.Of course if you are the life saved, you are grateful that the system exists.However my thoughts turn to the people that are over diagnosed. Once you have been informed that you have cancer, then your mind is in turmoil.

Over the years I have spoken to many people that have been newly diagnosed, with various different cancers.In instances that were considered less serious, and in the ‘watch and wait’ category, most people were very keen to do everything they could, to be rid of the cells, and live, ‘cancer free’. Even if this involved, complicated surgery, and a tough regime of treatment. It had started to effect them psychologically.I call this category of patient ‘the worried well’.They could be unaffected, physically for years, maybe forever, but decide that they can’t live with a cancer diagnosis.

I mentioned above about a PSA test for men, and below are some interesting findings.
The United States Preventive Services Task Force has analysed the data from the PLCO, ERSPC, and other trials and estimated that, for every 1,000 men ages 55 to 69 years who are screened every 1 to 4 years for a decade:

  • 0 to 1 death from prostate cancer would be avoided.
  • 100 to 120 men would have a false-positive test result that leads to a biopsy, and about one-third of the men who get a biopsy would experience at least moderately bothersome symptoms from the biopsy.
  • 110 men would be diagnosed with prostate cancer. About 50 of these men would have a complication from treatment, including erectile dysfunction in 29 men, urinary incontinence in 18 men, serious cardiovascular events in 2 men, deep vein thrombosis or pulmonary embolism in 1 man, and death due to the treatment in less than 1 man.

Before knowing any of the above statistics, I would always have said, that  you could never have too much screening. After all, surely early detection is a good thing? That is what everyone is telling us now. However, we have come to see that the tests we currently use as indicators, can only tell us so much.

I liken this scenario, to being told someone else’s secret. You didn’t ask, but now you have information you didn’t really want, and have to make choices. Your life has changed! Do something, do nothing, just live with it?

Until we are able to be much more precise with the tests we do, patients must be more aware of their options, and the possible consequences of their choices. There certainly are many different opinions and differing outcomes.This is where it gets tricky! You can only make a truly informed decision, if you have all the information. Even then, as we know, everyone is different. what is good for one person, is not so good for another.

I feel that if we have the facilities and capacity to early detect disease, then we should use it, even if it does have it’s drawbacks. These will certainly improve, with more accurate testing procedures. I also think that knowing what we know now about over diagnosis, will accelerate our work in improving these tests. After all, they cannot  take away breast screening now, and the pressure will only increase for a prostate test for men.

From what you have seen above, and if you were in charge of the health and finances in this country, what would you decide to do?

2 Comments

  1. Hi Chris,
    Liked your blog and always look forward to the next one.
    I was diagnosed with prostate cancer three months ago, had my prostate removed last Thursday, a week today, still have my catheter in place. You can imagine I’m not feeling great at the moment however I feel so lucky that I went to the doctor when I did. Early diagnosis might just help me that little bit more. I was told by my doctor and Urologist they didn’t “think “ I had cancer and hey presto!! I have it.
    If it was up to me I would have a routine PSA test in place, yes we might have over diagnosed people but in my case I was glad I did. I wanted to know if I had it and wanted a choice what to do. I was walking around getting on with my life not even knowing what a PSA test was. It was only because a prostate awareness group came to my bus garage where I work that I decided to do something. Maybe a letter in the post from your doctor to have a test from 50 onwards may not be such a bad thing. Now I’ve blown the NHS budget.
    When I tell my story to friends the first thing they say is how are you? And then I count the seconds and I know what’s coming next … “what made you go to the doctors? “.
    Why should it take someone with cancer to make people aware of a check up, we all know we should have checkups but a lot of us don’t.
    Sorry Chris, I’m going on about me me me.
    Well I won’t ask you” how are you” but I hope your ok and I thank you for these brilliant blogs that I enjoy so much.
    Hopefully I will see you at the prostate group next month, couldn’t make it this month, little sore down below.
    John

  2. Hi John
    Just love your comments and thank you for them! This blog is for you, you you. That is what it is all about, sharing experiences, so that we can all learn from each other.
    As you are aware from my own case and some of my previous posts, us men are shockers, when it comes to going to the doctor.Before I got into the cancer sector,I didn’t know what a PSA test was, and nor do any of my friends. I still feel that no one really thinks that it will happen to them, despite all of us knowing someone who is affected by cancer in one way or another.
    It feels like when we were young, and discussing pensions. None of us really worried too much, because we really believed that we weren’t going to get older!Before you know it, you are, and you haven’t made the right preparations.
    This is why I do a lot of the work I do, and why the blog is so valuable. I try and use easy to understand language, and talk about things as they really are.Hopefully to make people think about their own lives.
    I hope your recovery goes smoothly, and look forward to seeing you for the Christmas lunch! Thank you for taking the time to comment,which is very valuable for other readers. So glad you are enjoying my work, please tell your friends!!

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