Prostate cancer screening should not be available to the vast majority of men across the UK, a group of health experts has said, to the “deep disappointment” of several charities and campaigners.
Instead, the UK National Screening Committee (UKNSC) recommended creating a targeted screening program for men with a confirmed faulty variant of the BRCA1 or BRCA2 gene, meaning they are at greater risk of growing faster and having more aggressive cancer at an earlier age. Men According to them, representatives of this category can be examined every two years between the ages of 45 and 61 years.
The committee found that “the harms would outweigh the benefits” if it recommended prostate cancer screening for all men or men with a relevant family history of cancer, as it could lead to a small reduction in prostate cancer deaths but a “very high rate of overdiagnosis.”
When it came to screening black men, who are at increased risk of prostate cancer, the committee found that current evidence was “lack and uncertain.”
In response to the committee's draft recommendation, Health Minister Wes Streeting said he would “carefully consider the evidence and arguments in this draft recommendation.”
The draft recommendation will now be open to 12 weeks of consultation before the final recommendation is presented to the government in March.
Prostate cancer is the most common cancer in men, affecting one in eight men, with approximately 55,300 new cases diagnosed and 12,200 deaths each year. Despite being the second most common cancer in the UK after breast cancer, there is no screening programme, partly due to the unreliability of the prostate specific antigen (PSA) test.
One in four black men will be diagnosed with prostate cancer in their lifetime. Black men have a higher risk of late diagnosis of the disease than white men, but the committee did not recommend that they be screened due to a lack of data and uncertainty in existing data.
Screening black men could lead to “high rates of overdiagnosis and overtreatment,” the committee said, and its modeling found that an annual screening program for black men aged 55 to 60 would lead to “overdiagnosis” of 44% of prostate cancer cases. This is because some prostate cancers that grow slowly and are not aggressive do not necessarily require specific treatment.
The committee estimates that about 40-50% of prostate cancers detected through PSA screening will be slow-growing, and that further treatment and testing of these slow-growing cancers will lead to high rates of overdiagnosis and overtreatment, “causing unnecessary worry and lifelong side effects such as urinary incontinence, erectile dysfunction and bladder problems due to cancer that would never cause harm.”
The committee concluded that screening all men for prostate cancer in the UK, regardless of their risk, would only slightly reduce the number of deaths from the disease but would lead to “a very large number of men being overdiagnosed”. The committee also did not recommend screening for men with a family history of prostate, breast, or ovarian cancer for the same reasons.
BRCA1 and BRCA2 gene variants are defective genes that can increase a person's risk of developing breast, pancreatic, ovarian and prostate cancer.
It is estimated that approximately one in 300 to one in 400 people will have a defective BRCA1 or BRCA2 gene. Cancer UK study, many of whom are unaware of their status.
People of Jewish descent are at higher risk of having the defective gene, with one in 40 Ashkenazi Jews and one in 140 Sephardi Jews at risk.
Men are advised to talk to their GP about having a blood or saliva test for the defective gene if they have a strong family history of cancer.
Although the screening committee was unable to give an exact figure for the number of men who would be eligible for prostate cancer screening under its proposal, it is expected to be only a few thousand men given the rarity of the gene mutation.
While some charities welcomed the screening committee's decision, others and some public figures expressed “deep disappointment” that men at the highest risk of the disease would not be offered screening.
Cancer Research UK said it “supports[s] “The committee's conclusion is that for other groups of men, there is currently insufficient high-quality evidence that screening will provide more benefit than harm.”
Dr Ian Walker, executive director of policy at Cancer Research UK, added: “It can miss dangerous cancers and detect those that do not require treatment.
“Work is still needed to understand how the proposed screening program could be implemented and we look forward to UKNSC providing further details in due course.”
Professor Camila Hawthorne, chair of the Royal College of General Practitioners, also supported the committee's evidence-based approach to screening, adding: “The NSC's decision today not to recommend whole-population screening for prostate cancer reflects the lack of evidence that the PSA blood test is reliable enough to detect prostate cancer that requires treatment.”
However, charities Prostate Cancer UK and Prostate Cancer Research, as well as public figures including Stephen Fry and Rishi Sunak, expressed “deep disappointment” at the screening committee's decision and warned that many more men would be at risk of being diagnosed late or even dying from the disease.
Laura Kirby, chief executive of Prostate Cancer UK, said the decision was “a blow to tens of thousands of men, loved ones and families who have fought for the screening programme”.
Kirby added: “Although screening men with BRCA gene variants would save only a fraction of that amount, the committee's decision is the first time they have recommended any type of prostate cancer screening. It shows that research and evidence can make a difference and save men's lives.”
Prostate Cancer Research said excluding black men and men with a family history of the disease was “a serious mistake that ignores current evidence and risks widening health inequalities for the next generation.”
Fry and Sunak, ambassadors for prostate cancer research, expressed disappointment at the decision. Sunak said it was a “missed opportunity to make a difference for men's health” and Fry said: “Men in the UK deserve much better.”
Former Prime Minister David Cameron, who revealed earlier this week that he was being treated for prostate cancer also said he was “disappointed” with the decision. He added: “We will be letting too many men down if we do not insist on a wider screening program that includes all high-risk groups – and not just the men involved, but also their families, who risk losing a loved one unnecessarily.”
Streeting said: “I've always said I want screening for the most common cancer in men to be supported by evidence. I want to change the NHS so it diagnoses earlier and treats faster. That goal will be balanced against the harm that more widespread screening could cause for men.”
He added: “I will carefully consider the evidence and arguments in this draft recommendation, bringing together those with differing views, before making a final recommendation in March.
“In the meantime, we will continue to make progress in reducing cancer waiting times and invest in research into detecting prostate cancer. In the last 12 months, a further 193,000 patients were diagnosed with suspected cancer on time.”
