Why isn’t there a national screening programme for prostate cancer in England?
Until there is clear evidence to show that a national screening programme brings more benefit than harm, we will not be offering prostate cancer screening for asymptomatic men.
When considering population screening programmes the benefits and harms should be assessed and the benefits should always outweigh the harms. In 1968, Wilson and Junger of the World Health Organisation developed 10 principles which a national screening programme should meet. To date, we are only able to identify the first principle for prostate cancer screening:
- Important health problem
- Natural history well understood
- Recognisable at an early stage
- Treatment better at an early stage
- A suitable test exists
- An acceptable test exists
- Adequate facilities exist to cope with abnormalities detected
- Screening at repeated intervals when insidious onset
- Chance of harm is less than the chance of benefit
- Cost balanced against benefit
Evidence from a prostate cancer screening trial in Europe, ERSPC, has shown that screening reduced mortality by 20 per cent. However, this was associated with a high level of over treatment. To save one life, 48 additional cases of prostate cancer needed to be treated.
Following research evidence published in 1997 the UK National Screening Committee recommended that a prostate cancer screening programme should not be introduced in England. This policy was reviewed in Dec 2010 but no significant changes were made. It is due to be considered again in 2013/14, or earlier if significant new evidence emerges.