UK committee recommends against widespread prostate cancer screening

The Story

The UK National Screening Committee (UKNSC) has issued a final recommendation to the government advising against offering prostate cancer screening to most men using the prostate-specific antigen (PSA) test, concluding it is “likely to cause more harm than good.” The committee recommended screening only for men with the BRCA2 gene variant who also have a family history of certain cancers, estimating this would lead to “a few thousand” men being screened each year. The government will now consider the recommendation.

Key Facts

• Prostate cancer is the most common cancer in the UK, with more than 64,000 men diagnosed every year, and no national screening programme currently exists.
• The UKNSC’s final recommendation states that widespread PSA screening is “likely to cause more harm than good.”
• The committee recommended screening every two years for men aged 45 to 61 who have the BRCA2 gene variant and a family history of breast, ovarian, pancreatic or prostate cancers.
• Screening was not recommended for other at-risk groups, including black men, due to “ongoing uncertainty on whether screening would cause more good than harm.”
• Main harms cited include incontinence and erectile dysfunction in men who did not need treatment.
• The UKNSC chair, Prof Sir Mike Richards, said screening “can reduce deaths from prostate cancer to a small extent … and it does not improve overall survival.”
• He also said levels of overdiagnosis remain high despite advances such as MRI scans before biopsy after a positive PSA test.
• Of 100 men with a BRCA2 variant, between 21 and 35 will develop prostate cancer before age 80.
• The UKNSC’s draft recommendation in November had also included men with a BRCA1 variant, but new data led to their exclusion.
• Prof Anneke Lucassen said two large recent studies suggested the risk among those with BRCA1 was “significantly lower.”
• Prostate Cancer UK said only around one in every 300 to 400 people have BRCA gene variations, but as many as one in every 40 Ashkenazi Jewish people carry them.
• The NHS offers free BRCA gene testing for anyone aged 18 or over who has at least one Jewish grandparent.
• The government will consider the recommendation; Health Secretary James Murray will receive the committee’s advice on Monday.
• The UKNSC will work with the Transform trial, launched last year by Prostate Cancer UK, to gather more data.
• Dr Ian Walker of Cancer Research UK urged the government to accept the recommendation.

Conflicting Reports

The article notes that the decision “will come as a blow to campaigners” including Sir Chris Hoy, David Cameron, and Sir Stephen Fry, who have voiced support for more widespread screening. Chiara De Biase of Prostate Cancer UK said the charity was “deeply disappointed” with the recommendation, while Cancer Research UK urged acceptance.

Still Unclear

• How to identify men with the BRCA2 variant and invite them for screening, which the committee said would be evaluated over time with the NHS.
• Whether screening for black men would cause more good than harm; more research is needed, and the committee said it was “particularly important” that a “sufficient number” of black men be invited to the Transform trial.
• The government’s final response, which is expected to be updated “shortly.”

Misconceptions

The article directly addresses the misconception that screening is always beneficial. Prof Sir Mike Richards stated that screening does not improve overall survival, can cause long-lasting harm, and that “levels of overdiagnosis in prostate cancer remained high” despite advances.

Key Figures

• Prof Sir Mike Richards, chair of the UK National Screening Committee
• Anneke Lucassen, professor of genomic medicine and director of the Centre for Personalised Medicine, Nuffield Department of Medicine, University of Oxford
• Amy Rylance, director of health services, equity and improvement, Prostate Cancer UK
• Freddie Hamdy, Nuffield professor of surgery and professor of urology, University of Oxford
• Dr Ian Walker, executive director of policy, Cancer Research UK
• Chiara De Biase, fundraising and health strategy director, Prostate Cancer UK
• James Murray, health secretary (newly appointed)
• Sir Chris Hoy, six-time Olympic gold-medallist (campaigner)
• David Cameron, former prime minister (campaigner)
• Sir Stephen Fry, actor and author (campaigner)

Sources: The Guardian