Editorials

Screening for prostate cancer in the UK

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7316.763 (Published 06 October 2001) Cite this as: BMJ 2001;323:763

Seems to be creeping in by the back door

  1. Jenny L Donovan, professor of social medicine ([email protected]),
  2. Stephen J Frankel, professor of epidemiology and public health,
  3. David E Neal, professor of surgery,
  4. Freddie C Hamdy, professor of urology
  1. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. School of Surgical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  3. Division of Clinical Sciences, University of Sheffield, Sheffield S10 2JF

    Screening for prostate cancer is controversial. Findings from systematic and other reviews consistently conclude that there is insufficient evidence to recommend its introduction because of concerns that it may not improve survival or quality of life and may thus cause more harm than good.13 Current government policy in the United Kingdom, expressed in the NHS prostate cancer programme, confirms this view, but adds that “any man considering a PSA [prostate specific antigen] test will be given detailed information to enable him to make an informed choice about whether to proceed with a test or not.”4 This implies that asymptomatic men may have the test if they want, so there is now ambiguity about whether screening is supported and confusion about what this policy means in practice.

    The assumption may be that most men will not want to be tested once they are informed of the uncertainties. In the United States several studies have shown that informed choice can reduce prostate specific antigen testing in some groups by up to one half.57 But this may not apply in the United Kingdom. A systematic review of the use of decision aids has …

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