Prostate cancer screening should not be made available to the vast majority of men across the UK, a panel of expert government health advisers has said, to the “deep disappointment” of several charities and campaigners.
The UK National Screening Committee (UKNSC) has instead recommended that there should be a targeted screening programme for men with a confirmed BRCA1 or BRCA2 faulty gene variant, which means they are more at risk of faster growing and aggressive cancers at an earlier age. Men in that category could be screened every two years between the ages of 45 and 61, they said.
The committee found that the “harms would outweigh the benefits” if it were to recommend prostate cancer screening for all men or for men with a relevant family history of cancer, as it could lead to a small reduction in the number of prostate cancer deaths but “very high levels of over-diagnosis”.
When it came to screening black men, who have an elevated risk of prostate cancer, the committee found current evidence to be “lacking and uncertain”.
In response to the committee’s draft recommendation, the health secretary, Wes Streeting, said he would “examine the evidence and arguments in this draft recommendation thoroughly”.
The draft recommendation will now be open for a 12-week consultation before a final recommendation to the government is made in March.
Prostate cancer is the most common male cancer, affecting one in eight men, with about 55,300 new diagnoses and 12,200 deaths every year. Despite being the second most common cancer in the UK after breast cancer, there is no screening programme in place in part due to the unreliability of the prostate specific antigen (PSA) test.
One in four black men will be diagnosed with prostate cancer in their lifetimes. Black men have a higher risk of a late-stage diagnosis of the disease than white men, but the committee did not recommend they should be screened, due to lack of data and uncertainties in the existing data.
Screening of black men could lead to “high rates of overdiagnosis and overtreatment”, the committee said, with its modelling finding that an annual screening programme for black men aged between 55 and 60 would lead to 44% of prostate cancers being “overdiagnosed”. This is because some prostate cancers that are slow-growing and not aggressive would not necessarily require certain treatments.
The committee estimated that about 40-50% of prostate cancer cases detected by PSA screening would be slow-growing, and that further treatment and testing for these slow-growing cancers would lead to high levels of overdiagnosis and overtreatment, “causing unnecessary anxiety and lifelong side-effects such as incontinence, erectile dysfunction and bladder problems for a cancer that would never have caused 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 to be overdiagnosed”. Men with a family history of prostate, breast or ovarian cancer were also not recommended for screening by the committee for similar reasons.
BRCA1 and BRCA2 gene variants are faulty genes that can increase a person’s risk of developing breast, pancreatic, ovarian and prostate cancer.
About one in 300 to one in 400 people will have a faulty BRCA1 or BRCA2 gene, according to Cancer Research UK, with many being unaware of their status.
People with Jewish ancestry are at a higher risk of having the faulty gene, with one in 40 Ashkenazi Jews and one in 140 Sephardi Jews being at risk.
Men are encouraged to speak to their GP about getting a blood or saliva test for the faulty gene if they have a strong family history of cancer.
Although the screening committee could not give an exact figure on the number of men who would be eligible for prostate cancer screening under its proposal, it is expected to only be a few thousand men given the rarity of the gene mutation.
Although some charities have welcomed the decision by the screening committee, others and some public figures have expressed “deep disappointment” that men with the highest risk of the disease would not be offered screening.
Stephen Fry: ‘Men in the UK deserve so much better.’ Photograph: Karl Black/Alamy
Cancer Research UK said it “support[s] the committee’s conclusion that for other groups of men, there isn’t currently enough high-quality evidence that screening would do more good than harm”.
Dr Ian Walker, the executive director of policy at Cancer Research UK, added: “It can miss dangerous cancers and detect ones that don’t need treatment.
“Work is still needed to understand how the proposed screening programme could be delivered, and we look forward to the UKNSC setting out further details in due course.”
Prof Kamila Hawthorne, the chair of the Royal College of GPs, also supported the committee’s evidence-based approach to screening, adding: “Today’s decision by the NSC not to recommend whole-population screening of men for prostate cancer reflects the lack of evidence that PSA blood testing is reliable enough to detect prostate cancer that needs treatment.”
However, the charities Prostate Cancer UK and Prostate Cancer Research, alongside 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 late diagnosis or even death from the disease.
Laura Kerby, the chief executive of Prostate Cancer UK, said the decision came as a “blow to the tens of thousands of men, loved ones and families who’ve fought for a screening programme”.
Kerby added: “While screening men with BRCA gene variations will save only a fraction of that, the committee’s decision is the first time they’ve recommended screening of any kind for prostate cancer. It shows that research and evidence can shift the dial and save men’s lives.”
Prostate Cancer Research said that excluding black men and men with a family history of the disease was a “serious error that ignores modern evidence and risks widening health inequalities for another generation”.
Fry and Sunak, ambassadors for Prostate Cancer Research, both expressed disappointment in the decision. Sunak said that it was a “missed opportunity to make a generational difference to male health”, while Fry stated: “Men in the UK deserve so much better.”
The former prime minister David Cameron, who revealed earlier this week that he had been treated for prostate cancer, also said he was “disappointed” in the decision. He added: “We are letting down too many men if we don’t push for a wider screening programme that includes all high-risk groups – and not just the men involved, but their families too, who risk losing a loved one unnecessarily.”
Streeting said: “I have always said I want to see screening in place for the most common cancer in men, provided this is backed by evidence. I want to change the NHS so it diagnoses earlier and treats faster. That aim will be balanced against the harms that wider screening could cause to men.”
He added: “I will examine the evidence and arguments in this draft recommendation thoroughly, bringing together those with differing views, ahead of the final recommendation in March.
“In the meantime, we will keep making progress on cutting cancer waiting times and investing in research into prostate cancer detection. In the last 12 months, 193,000 more patients received a diagnosis for suspected cancer on time.”
