This is Everyday Science with Clare Wilson, a subscriber-only newsletter from The i Paper. If you’d like to get this direct to your inbox, every single week, you can sign up here.
Hello, and welcome back to Everyday Science.
In the past few months, I have been lucky enough – or unlucky, depending on how you view it – to get letters from my GP inviting me to have a screening test for firstly cervical cancer and then breast cancer.
My male partner, on the other hand, feels ignored when it comes to cancer screening. The NHS has no official prostate cancer screening programme – although men can proactively ask for the PSA blood test that indicates higher risk of the condition if they are over 50.
Olympic champion Sir Chris Hoy has been calling for this to change through a national screening programme, and for the age guide of 50 to be abolished.
Hoy – who bravely revealed last year that he has been diagnosed with terminal prostate cancer and has vowed to raise awareness of the disease – is supported by at least two UK medical charities and a national newspaper in calling for screening to be extended.
This week, some headlines suggested Health Secretary Wes Streeting has also given his support to the campaign. Streeting appeared to choose his words carefully, in that he spoke supportively about the need for better ways to diagnose prostate cancer, while saying the decision was down to an expert panel called the National Screening Committee.
As many doctors and scientists believe the evidence does not yet support a screening programme, the NSC’s decision is more uncertain than some of the headlines suggested. But why is there so much debate around prostate screening and where does that leave men who are considering taking the test?
Prostate cancer is one of the most common forms of cancer, affecting about one in eight men. Its prognosis is highly variable, as most tumours are slow-growing. It is said that nearly all men would develop prostate cancer if they lived long enough – more men die “with” the condition, than “from” it.
However, some tumours are aggressive – and deadly – and obviously these are the kind that men would benefit from advance warning about.
As the blood test for PSA can shed light on the prostate gland’s health, there have long been calls for the NHS to set up a national screening programme to detect cancers early.
The problem is that screening programmes for any medical condition have the potential to do more harm than good. When it comes to prostate cancer, the main risk is detecting tumours that are slow-growing and would have never gone on to kill.
Sir Chris Hoy announced that his cancer was terminal in October last year (Photo: Visionhaus/Getty)That’s worrying, because the treatments for prostate cancer, such as radiotherapy or surgery, often damage nerves, leading to impotence or incontinence. “That can be devastating,” said Professor Jenny Donovan, a professor of social medicine at the University of Bristol, who was involved in the largest-ever trial of prostate screening, published last year.
That trial, which was done in the UK, found that offering men a PSA test led to no significant difference in the number of deaths between the men offered screening and those who weren’t. That’s probably because the test is bad at detecting the aggressive tumours that grow quickly and are most likely to be deadly.
On the other hand, screening does find the slow-growing tumours that cause PSA levels to rise gradually over many years. But in many cases these probably wouldn’t have spread and gone on to kill, or even cause any symptoms.
Because of that trial and others, the current NHS position is that screening does more harm than good. And so, for now, men don’t get any prostate screening invites through their door.
Looking for cancers
But it is hard to explain why prostate screening can be harmful in the face of such emotional campaigns, said Professor Freddie Hamdy, a urologist at the University of Oxford, who was also involved in the large trial. He said the public assumes: “We must go out and find all these cancers.”
“People don’t realise what the consequences on the larger population is going to be,” he added.
Various strategies have been proposed for making screening methods more accurate. One is to offer the PSA test to groups known to be at higher risk of prostate cancer, for instance black men, or people with a family history of prostate cancer.
But the same goes for these people too – before any screening programme can be rolled out, it needs to be shown in a randomised trial that it does more good than harm, said Professor Hamdy.
He added, however, that men with relatives with prostate cancer should discuss their level of risk with their GP.
Another possibility is for doctors to calculate someone’s genetic risk of prostate cancer – and this week a study showed that a genetic test based on a saliva sample can add further information. The study was published in the New England Journal of Medicine.
Yet while these results are promising, the study did not assess if a screening programme based on the genetic test would save lives, nor if it would overall do more good than harm.
While the test “could supplement existing screening in high-risk individuals, the evidence is insufficient to recommend a standalone screening programme,” said Professor Dusko Ilic, a stem cell researcher at King’s College London, who was not involved in the study.
For men who are weighing up what to do, Streeting’s latest statement doesn’t really clarify things. He told The Daily Mail this week that he hopes the UK’s National Screening Committee “can recommend a way forward that allows the NHS to seek out prostate cancer more proactively for those most at risk”.
But he also said “any programme must be evidence-led and clinically led”. To me that indicates he will leave the decision up to the committee.
Men should be aware, though, that even without a personal invitation for screening through their door, they can still ask their doctor for PSA test if they would like one, even if they are under 50. A GP can still order them the test at their discretion. And anyone with symptoms suggestive of prostate cancer, like frequent urination, is also advised to see their doctor.
At whatever age, a decision on screening is a very personal one and I’m not trying to steer anyone either way. Professor Hamdy believes people should consider their options carefully, saying: “We see websites saying, ‘Go and get tested – it’s just a blood test.’ It isn’t just a blood test. It’s more complex.”
I’ve also written…
A growing number of us are choosing drinks with artificial sweeteners, either for health reasons, or because the diet version is a little cheaper, thanks to the 2018 drinks “sugar tax”.
But alarmingly, a government advisory committee said last week that people should minimise their intake of sweeteners and that young children should not be given them at all, due to inconsistent supporting evidence. Consumers could be forgiven for wondering what’s going on, as I explain here.
I’ve been watching…
While somehow overlooking the first two series, I’ve become addicted to the third series of The White Lotus, a funny and cynical drama set in a luxury Thai hotel, about the messy lives of the super-rich.
Speaking of holidays, this newsletter will pause for a week while I take one of my own. See you in a fortnight.
Read More Details
Finally We wish PressBee provided you with enough information of ( Sir Chris Hoy wants to extend prostate cancer testing. Some doctors don’t agree )
Also on site :
- Who Is FSU Shooting Suspect Phoenix Ikner? What We Know
- Man shot and killed by police in Golden Hill this week identified as Enrique Cortez, 37
- Iran responds to Trump: We’ll defend ourselves