Streeting should ‘channel Thatcher' and introduce prostate screening

Telegraph

2 days ago

Wes Streeting should 'channel Margaret Thatcher ' and introduce screening for prostate cancer without delay, one of the world's leading experts has said.
Prof Jonathan Waxman, the founder of the charity Prostate Cancer UK, says the Health Secretary should learn from Thatcher's decision to introduce routine mammograms for women, which he said had saved 3,000 lives a year since they were introduced in 1988.
The Telegraph has launched a campaign calling for the introduction of targeted screening for prostate cancer so those at high risk are automatically offered tests.
Prostate Cancer UK has submitted evidence in favour of the policy to the UK National Screening Committee (UKNSC), which is currently considering the matter, with a decision expected later this year.
Writing for The Telegraph, Prof Waxman said: 'There are interesting parallels between the prostate cancer and breast cancer screening stories.
'In the 1970s, before breast cancer screening was introduced by Government dictat, the medical consensus was, and, you have guessed it, that early diagnosis through screening mammography would not save lives.
'Mrs T, regardless of the medical consensus, waved her handbag at the doctors, ignored the consensus, and launched a screening programme for breast cancer. And the result? Screening mammography, together with treatment advances, has led to a massive improvement in survival from breast cancer.
'Before screening, just 65 per cent of patients with breast cancer survived and now over 80 per cent are cured as a result of early detection and better treatment.
'And how does this improvement manifest in the real world? Around 3,000 fewer women die each year in the UK from breast cancer than before the screening programme was introduced.'
The emeritus professor at Imperial College London said Prostate Cancer UK led a consortium of men's health charities to collectively inform the committee on the importance of targeted screening for those at highest risk.
But he said the NHS should act now so that GPs do far more to help men at risk of prostate cancer. He urged the NHS to rewrite its guidance so that family doctors are told to proactively start conversations with men about the PSA blood tests which can detect the disease.
Current guidance says that men can ask for a test, though some GPs rebuff them. For younger men, including those with a family history of disease, offering a test is down to the clinical judgment of GPs about.
In both cases, the onus is on patients to seek help in the first place, with many men including those with family histories of prostate cancer unaware they are at heightened risk of the disease.
Prof Waxman said the NHS should rewrite its advice so that GPs are told that they should bring up prostate cancer with all patients who might be at extra risk.
He added that the guidelines should suggest that GPs start conversations with men from the age of 45 at highest risk, so those who wish to can obtain a PSA test.
'This puts the power of informed choice back in the hands of men who need it the most and is a crucial step on the path to early diagnosis,' he says.
In the past, screening advisers have rejected the practice on the grounds that the tests are too unreliable, and could result in too many men undergoing needless procedures.
However, in recent years the back-up diagnostics used to confirm the initial test findings have significantly improved.
A Department of Health and Social Care spokesman said: 'This Government has been clear we would like to see screening in place, but the decision must be evidence-led.
'The UK National Screening Committee is looking at this as a priority – including reviewing the evidence for screening men with a family history of prostate cancer.
'While the review is taking place we are getting on with improving cancer treatment and prevention, as well as funding tens of millions of pounds of research – GPs should consider risk factors and use clinical judgment when considering if patients need a prostate cancer test.'
Prostate cancer is a lot more than a nuisance
By Jonathan Waxman
Sixty years ago, around 10,000 people in the UK were diagnosed annually with prostate cancer. Currently over 50,000 men are diagnosed each year and prostate cancer has the dreadful distinction of being the commonest cancer in men.
In parallel, the number of prostate cancer deaths has increased from 3,300 to over 12,000 men annually.
So, what to do?
We can hope that the treatment of prostate cancer will improve and improve, and cures are found.
Treatment is getting better. Thankfully, in 2025, well over 80 per cent of men with prostate cancer that has not spread beyond the prostate will be cured and the duration of survival for men with cancer that has spread has doubled compared with 25 years ago. These improvements have come because of modern medicine's marvellous miracles, developing from brilliant university research and big pharma's R & D. Prostate Cancer UK has invested over £120m in research over the years.
But clearly despite the gloss of shiny medical breakthroughs, prostate cancer remains a fundamentally unpleasant problem, and a lot more than a nuisance.
What can be done?
Find it early, you say?
Yes, that would seem logical.
How do we do this?
Well, if we want to find prostate cancer early then the obvious answer is to screen for prostate cancer. There is no UK screening programme for the early detection of prostate cancer, a cancer which is often without symptoms. The National Screening Committee is currently considering the role of screening for prostate cancer. Prostate Cancer UK has led a consortium of men's health charities to collectively inform the committee, which advises government, on the importance of targeted screening for those at highest risk.
There are interesting parallels between the prostate cancer and breast cancer screening stories. In the 1970s, before breast cancer screening was introduced by Government dictat, the medical consensus was, and, you have guessed it, that early diagnosis through screening mammography would not save lives.
Mrs T, regardless of the medical consensus, waved her handbag at the doctors, ignored the consensus, and launched a screening programme for breast cancer. And the result? Screening mammography together with treatment advances have led to a massive improvement in survival from breast cancer. Before screening, just 65 per cent of patients with breast cancer survived and now over 80 per cent are cured as a result of early detection and better treatment.
And how does this improvement manifest in the real world? Around 3000 fewer women die in the UK from breast cancer each year than before the screening programme was introduced.
To return to the debate on screening for prostate cancer. We are now at a critical inflection point in the history of prostate cancer screening. Last year, Prostate Cancer UK published research that showed prostate cancer diagnosis is safer and more accurate than ever before, and this in part is thanks to research the charity funded leading to MRI – Magnetic Resonance Imaging – being introduced into the diagnostic pathway.
The National Screening Committee, under the iron baton of its excellent chair, is currently deliberating on the evidence for and against screening for prostate cancer and will issue a report this year. In heavily trailed remarks, Wes Streeting has indicated that he is in favour of screening but not for everyone, just for selective high risk groups of men.
We at Prostate Cancer UK welcome this ministerial support, for it is also our view that there is a need for screening, and we believe the evidence is now there for targeted screening. We welcome his remarks at a time when we are about to launch TRANSFORM, a multi-centre screening trial using sophisticated technologies based on current diagnostic tools, an adaptive trial that is open to new screening tests. Prostate Cancer UK's trial invests £42m in a very long-term campaign to assess the survival benefits of modern screening methods.
So, who are Mr Streeting's selective high risk groups of men at increased risk of prostate cancer? These are men with family histories of prostate cancer who constitute 1 to 5 per cent of all diagnosed patients, and black men, who have a one in four risk of prostate cancer, which is twice the risk of white men.
What to do whilst we await the Screening Committee's conclusions?
Currently GP guidelines concerning testing for prostate cancer are outdated. We urgently need these NHS guidelines updated to empower GPs to proactively start conversations about PSA testing with men from the age of 45 at highest risk. This puts the power of informed choice back in the hands of men who need it the most and is a crucial step on the path to early diagnosis.
So, yes, prostate cancer is a bit of a nuisance, but let us see if we can do something about that nuisance.
Prof Jonathan Waxman OBE is the founder and president of Prostate Cancer UK