Screening Woes

Screening is difficult. Even NHS hospitals get it wrong

The Unfortunate Patient

Sixty-seven year old Vincent O'Dea took up a 'MOT Health Check' at his GPs, which showed a slightly raised PSA. As a result of this he's now had 37 sessions of radiotherapy - with all the adverse effects that implies.

Is he better off? Probably not.

We know that 50% of men aged 50 have prostate cancer. How many of these will be bothered by that cancer during their lifetime? - Very few. How many will die of that prostate cancer - even fewer. We don't know how to spot which men will have poor results without treatment - so population screening leads to massive over treatment and net harm (It's even worse than that, as we don't know which treatment is best even if we could spot the men who might benefit from it, so chances are the men who are getting overtreated aren't even getting the best treament).

The age standardised mortality rate from prostate cancer in the UK in 2011 was 23.7 per 100,000 men. Three quarters of those deaths were in men over the age of 75.

So what has Mr O'Dea gained from his PSA test? He got 37 sessions of chemotherapy in the North Middlesex University Hospital's TrueBeam Linear Accelerator... is that the reason that the hospital is promoting screening - to fill their expensive radiotherapy machine?

Mr O'Dea of course is convinced that his PSA test has saved his life. This is a common misaprehension. He'd probably have been better off avoiding this.

The discoverer of PSA has stated that it shouldn't be used for screening.

This hospital should be talking to their local Director of Public Health and the National Screening Committee before indulging in this exercise which seems to be aimed at revenue generation rather than benefiting the health of their local population.