Letters Screening for prostate cancer

Consider the harms

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5811 (Published 26 October 2010) Cite this as: BMJ 2010;341:c5811
  1. Susan Bewley, consultant obstetrician1
  1. 1King’s Health Partners, London SE1 7EH, UK
  1. susan.bewley{at}gstt.nhs.uk

The editorial linked to a research paper showing no significant impact of prostate cancer screening on overall or disease specific mortality concluded, “clinicians are advised to individualise their approach to PSA [prostate specific antigen] based screening. Young men at high risk of prostate cancer, such as those with a strong family history and higher baseline PSA concentrations, should be followed . . . Conversely, elderly men and those with a low risk of disease could be tested less often, if at all.”1 2

This is not a description of screening that delivers more good than harm to a well population. It is easy to miss that the conclusion assumes that in both cases screening by history and PSA testing have been performed. Thus, a mangling of language, unsupported by the science, “normalises” and promotes PSA testing. Maybe such bias from a US author who declares 20 commercial relationships in the past three years is unsurprising, but UK readers should beware. The UK has no organised screening programme for prostate cancer for good reason. Patients may be grateful for early (over)diagnosis of cancer, but doctors testing without proof of saving lives are still responsible for the anxiety and impotence they will inevitably cause despite the NHS Screening Committee’s excellent “informed choice programme” leaflets.3


Cite this as: BMJ 2010;341:c5811


  • Competing interests: Committee member of Healthwatch, a charity for treatments that work.


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