Should We Increase Cancer Screening?

Logic of course tells us that we should be doing more, by improving, and increasing our cancer screening programmes. If you are one of those many people whose life has been saved by early screening, you will of course be advocating for this. Personally, I’m not entirely convinced. My heart of course says yes, but my head says no. Certainly not in these challenging times. Currently, cancer seems to be nowhere near urgent for any leadership, in any country. I barely hear the subject mentioned, unless in continual depressing communications from the media, involving the NHS and waiting times.

What Is Screening?

Screening means testing people for early stages of a disease. This is before they have any symptoms. For screening to be useful the tests:

• need to be reliable at picking up cancers
• overall must do more good than harm to people taking part
• must be something that people are willing to do

Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.

We now have record waiting times, and still issues seeing GPs. Therefore we cannot truly cope with the cases we are finding. We currently have 3 nationwide screening programmes. For breast cancer, bowel cancer and cervical. Some was placed on the ‘back burner,’ during covid. I wouldn’t say that even pre-existing programmes are back to ‘normal,’ yet. With the cost-of-living crisis hitting us all, we must now start to consider what impact our spending is having. So, I had a look around at some statistics.

On average more than 2 million women are screened for breast cancer in the UK. The current evidence suggests that breast screening reduces the number of deaths from breast cancer by about 1,300 a year in the UK. As well as finding cancers that need treating, screening can also pick up breast cancers that won’t ever cause any problems. At the moment it isn’t possible to know whether a breast cancer will grow quickly and need treatment, or will grow slowly, or not at all. So, almost all women diagnosed have surgery to remove the cancer. Many also have radiotherapy, hormone therapy or chemotherapy. For some women the treatment is unnecessary but at the moment doctors can’t tell who needs treatment and who doesn’t.” Source CRUK The total cost being approximately £100 million per year.

Regarding cervical screening, approximately 30% of people do not take up their invitation to be tested. Quite shocking, when apparently 83% of deaths could be prevented with an early diagnosis. There are currently approximately 2700 women diagnosed annually. The uptake for bowel cancer is currently 71%. There is a lot of discussion around screening for prostate cancer now. Although currently there isn’t one reliable test. PSA is the one that most people talk about currently. But most professionals do not view it as reliable enough to roll out nationally.

Of course, the current system is far from perfect. But whilst we have these screenings in existence, it will encourage many to think about their health. Which is the real positive. However, on a purely financial basis, I’m not convinced of the value for money. Many creating the ‘worried well’ in society. ‘Over treating’ in many cases. Costing millions in unnecessary treatments and care. The more cancer we look for the more we will find. I believe we need to re-evaluate what we really want to achieve from our efforts and financial resources. Continuing on the same path is no longer an option. It will only bring the same results which are clearly not working.

Shouldn’t we be looking at better prevention? Many still believe that there is only one disease. There are in fact hundreds of course. You can now understand how far away we really are from finding a cure. My personal long-term hope is genomics, but I’m unlikely to see real improvement in my time. However as public healthcare becomes more difficult, I’m seeing an increasing number of adverts for genomic profiling. This service offers to analyse a blood sample and see the likelihood of any serious diseases, possibly coming your way in the future.

Does everyone want to know what disease they may or may not get in future years? Many might consider this idea incredibly positive. It may well prevent many premature deaths and save our healthcare a lot of money. A great investment of resource if this is the case. My real concern is that our health system would quickly break. Busy with people wanting meaningless tests and treatment. For issues they may not live long enough to see. I had a free test by a private company who wanted to try it on me. I agreed, only because of my personal cancer situation and being older. Not worrying about my future. There was one very disturbing result, which is now on my mind daily. Although nature will just take its course.

I’m sure that almost everybody reading this piece will think I’m crazy to even question an increase in screening. But I’m still not convinced it is right, with the immediate state of healthcare. We have neither the resources nor the finance to even think about it currently. Of course, there is the big argument about earlier diagnosis saving lives, and ultimately costing us less. Which is absolutely true, in an ideal world. However, we have not been in that place for a very long time.

Yes, I want to see things improve dramatically, which they can with the right people in charge. Logic would say that an increase in screening opportunities would be a massive forward step. But I’m more convinced that we need to be looking harder at prevention rather than cure. As always, I would love to know your own views and arguments. Please feel free to share them in the comments below.