Download Screening for Cancer - St Wulfstan Surgery

Dr Grania O’Mahony MBBS DRCOG DCH
Dr Tim Coker MBBS DA DRCOG
St Wulfstan Surgery, Northfield Road, Southam, CV47 0FG
Tel: 01926 810939 • fax: 01926 810935
www.stwulfstan.co.uk
07 May 2017
Screening for Cancer – why breast but not prostate?
It may seem peculiar that so much effort goes into screening for breast and cervical cancer
and yet little attention is paid to prostate cancer. In the last few years the NHS has also
introduced a national screening programme for bowel cancer. In the private sector, BUPA
and similar companies offer blood tests for prostate screening – so why not the NHS?
The answer to that is not as simple as it seems. In 1968 the World Health Authority wrote
that a screening programme must fulfil various criteria before being introduced. These are:
1. The condition is an important health problem
2. Its prognosis is well understood
3. It is recognisable at an early stage
4. Treatment is better at an early stage
5. A suitable test exists
6. An acceptable test exists
7. Adequate facilities exist to cope with abnormalities detected
8. Screening is done at repeated intervals when the onset is insidious
9. The chance of harm is less than the chance of benefit
10. The cost is balanced against benefit
Prostate cancer is the most common cancer in men, affecting 1 in 14 in their lifetime. So,
the first criterion is met – but the rest of the list of criteria is not. Rectal examination by a
doctor is the commonest test but also very unreliable. The PSA blood test (prostate specific
antigen) can give a falsely high result when there is no cancer present, or can be low when
it is present. More unpleasant tests involve a biopsy of the prostate with a needle through
the rectum, and even that is not 100% reliable – although it is 100% uncomfortable! And
then, on top of that, there isn’t yet full agreement on what the best treatment should be, or
even how effective the different treatments are. You can find lots more details about this,
and other screening, at www.cancerscreening.nhs.uk. The current NHS view on prostate
cancer screening is that if you have symptoms (which are the same as in a normal aging
man: a sense of urgency in needing to pass urine, but hesitation and poor flow when you
get to the toilet, and also getting up several times at night for a wee) and if you want to be
tested, then you should see your GP. You should discuss your worries about it, and then
take an informed decision as to whether to have the rectal examination and the PSA blood
test. But remember, a positive blood test might then lead to further less pleasant tests, when
all the time you may not have prostate cancer anyway. For those people who are unlucky
enough to have prostate cancer, the next step is to decide on what treatments if any are
recommended. Not all prostate cancers are serious. Half of 80 year old men have it but only
1 in 30 die of it, so the treatment might not even be necessary. The difficulty for the
specialist is that at the moment there is no simple way of knowing whether one cancer is
serious and another not.
Breast screening is completely different. Breast cancer affects about 1 in 12 women in
their lifetime and women are invited for an Xray from the age of 50 until they are 70, every
three years. After the age of 70, women are no longer routinely invited for screening, but
they can continue to have the Xray if they make their own appointment. Breast screening
was started in the UK in 1988 and is thought to save 1400 lives every year. Women under
the age of 50 are not invited because Xrays are not the best way of examining ‘younger’
breasts. Breast self examination is always important but in the under 50s is the best way of
detecting early cancer and has been shown to save lives. For more details of how to do this
visit www.stwulfstan.co.uk. After the menopause the consistency of the breast tissue
changes, and Xrays can detect abnormalities more easily. About a third of all breast cancers
are found in women over the age of 70 years, and so it is important that they continue to
have three yearly breast screening. You can invite yourself to screening by ringing the local
breast screening unit (02476 844155) or contacting NHS Direct on 0845 46 47 who should
be able to tell you the address.
Cervical screening is slightly different in that it is not looking for a cancer, but for a
change in cells, that, if left, can turn into cancer. The NHS national cervical screening
programme was introduced in 1988. It is offered to all women between the ages of 25 and
64, with recall every 3 years until the age of 50, and then every 5 years after that. Cervical
cancer under the age of 25 is very rare and the test can be unreliable in very young women.
Many women who develop cervical cancer have never been screened. So screening is very
important, particularly in women who started having sex at a young age, have had many
sexual partners and who smoke. It is estimated that 75% of cervical cancers are prevented
by the cervical screening programme.
Bowel Cancer Screening is the most recent addition to the NHS screening programme.
Bowel cancer affects about 1 in 20 people in their lifetime, and it is the second commonest
cancer in the UK. Coventry and Warwickshire have been involved in the pilot project
before it is rolled out countrywide. As the programme develops, people between the ages of
58 and 69 years will be sent a kit in the post every two years which needs to be used and
returned to the screening laboratory. It detects microscopic levels of blood in the stool
(faeces) which can indicate very early cancers or even growths that might become
cancerous later. People found to have blood in the faeces will be offered a colonoscopy (a
camera up the bowel via the rectum) for a full thorough check. It is not a perfect test: about
1 in 1000 people with no blood in the faeces will get bowel cancer in the following two
years. Because of this, symptoms which last more than 6 weeks of abdominal pain, change
in bowels (particularly looseness), bleeding from the rectum or weight loss should be
reported to your GP. People over the age of 70 who wish to be involved in the study can
ring 0800 783 8042 to ask to be sent a testing kit.
Screening is one of the great successes of the NHS but is expensive and complicated. The
cervical screening programme alone involves about 100,000 people along the line when
you count the doctors, nurses, lab staff and administration. Prevention is better than cure,
but where prevention is not possible, early warning is the next best thing.