The pandemic has disrupted cancer diagnosis and treatment in healthcare systems around the world. In response, patients at risk of cancer have been encouraged to attend health services to support rapid diagnosis. In England, this has included a collaboration between the NHS and Prostate Cancer UK to find the estimated 14,000 men who have not yet started treatment for prostate cancer due to the pandemic.
Inviting people without symptoms to be screened for prostate cancer is currently not recommended and should be approached with caution because, for most men, the benefit is small and uncertain and there are clear harms, they warn. today the experts at The BMJ.
NHS England teamed up with Prostate Cancer UK earlier this year to find the estimated 14,000 men who have not yet started treatment for prostate cancer due to the pandemic. However, experts warn that prostate cancer screening is currently not recommended by the UK National Screening Committee.
The National Institute for Health and Care Excellence (NICE) advises GPs that "testing should not be offered to asymptomatic people", even if a patient who has been informed of the potential harms and benefits You can request a test.
The campaign encourages men to use a "risk checker" and, if concerned, speak to their GP about possible next steps, including a prostate-specific antigen (PSA) test.
However, in the UK and US, routine PSA testing is not recommended because research has shown that the test can, at best, prevent one death from prostate cancer per 1,000. patients examined for 10 years.
PSA testing also carries a risk of overdiagnosis : healthy men being unnecessarily diagnosed and treated for harmless, slow-growing tumors.
While the authors acknowledge that the campaign’s message aligns with the established principle of allowing patients to decide for themselves about PSA testing, and the risk checker provides valuable information, they say that encouraging all older asymptomatic men 50-year-olds to make an appointment with their GP to discuss their risk "seems to depart from this cautious approach" and also has resource implications.
The fact that the campaign encourages screening for asymptomatic illness could lead people to believe that the NHS is promoting screening, experts add.
In the UK and US, asymptomatic men can opt for a PSA test after exploring their options with their doctor. However, experts suggest that reaching a shared decision about the value of a PSA test is complex and time-consuming.
"GPs and patients need practical, up-to-date guidance on PSA testing, including recommended evidence-based tools and resources to support shared decision-making," the authors write.
“If a risk verification tool is to be promoted as part of an early detection strategy, the tool must be evidence-based and appropriately evaluated.”
Better ways to detect prostate cancer earlier are being evaluated, but in the meantime, "efforts must continue to focus on rapidly diagnosing symptomatic patients and generating evidence of the clinical and economic effectiveness and safety of any national screening program." detection," they conclude.
Clarity, consistency and support. Information to the public should emphasize that although PSA testing is available on request for men over 50, it is not currently recommended and why. Whether asymptomatic men over 45 years of age in certain risk categories should be eligible for PSA testing, this should be indicated in national guidance, which has not been updated for more than six years. GPs and patients need up-to-date practical guidance on PSA testing, including recommended evidence-based tools and resources to support shared decision-making. If a risk verification tool is to be promoted as part of an early detection strategy, the tool must be evidence-based and appropriately evaluated. In the meantime, efforts should continue to focus on ensuring rapid diagnosis of symptomatic patients and generating the evidence necessary to satisfy the National Screening Committee of the clinical and economic effectiveness of any proposed screening program. |
