Feature: What companies don’t tell you about screening
Personal View: Routine testicular self examination: it’s time to stop
In a feature published today on bmj.com, general practitioner Margaret McCartney looks into whether customers of private screening companies fully understand what they are undertaking.
She asks whether the advertisements and "personal-looking" letters from private screening companies are offering something that is of benefit to their customers. She argues that the promotion of these services “contrasts with the stance of the NHS” which only introduces screening programmes after a solid review by the UK National Screening Committee (UK NSC).
Dr Anne Mackie, the UK NSC Director of Programmes supports Dr McCartney’s views stating that “Screening tests should be offered only when there is evidence that their use in asymptomatic populations will produce more benefit than harm”.
Dr McCartney also looks into a Which? study that investigates the quality of information given to people who are thinking about having a private screening for conditions such as cardiovascular disease, chance of stroke, lung cancer and diabetes.
Which? say they were “concerned about the quality of information given to people making important decisions about whether or not to use them”. It looks at a report by the Committee on Medical Aspects of Radiation in the Environment (COMARE), which recommended regulation of private screening clinics and say that customers should be made aware of the rates of false positive and false negative results”.
The BMA and the Academy of Medical Royal Colleges have both expressed concern in a letter to Andrew Lansley in 2010, asking for improvements in the information on false positive and negative results, risks and limitations of screening tests. However, no legislation has followed.
Dr McCartney asks who is responsible for ensuring advertising is balanced and that standards are regulated? After she and several colleagues complained to the General Medical Council they were told that advertising investigations cannot take place without evidence that the doctors “did not fully explain the risk / benefits of the procedures”.
Dennis Ager, lead officer for health at the Trading Standards Institute says that “inaccurate advertisements can be […] treated more seriously when there is evidence of harm or injury to people” but this enforcement has yet to be applied to private screening clinics. The Department of Health has asked the Royal Colleges of Radiologists and Physicians to produce guidelines on the use of radiation by private clinics, but there is as yet no publication date. And, Dr McCartney concludes, while the adverts for private screening continue to “pull people in”, the NHS is left to “sort the fallout.”
In a personal view, Keith Hopcroft, a general practitioner in Essex, looks at evidence suggesting that testicular self-examination causes more harm than good.
Dr Hopcroft argues that the use of celebrities to promote testicular self-examination, such as Robbie Williams and the Leicester Tigers rugby team and the specific message that “any self-respecting bloke should regularly examine his testicles” is based on a “well meaning whimsy” with potentially harming effects.
Dr Hopcroft says that self-examination may have stemmed from the myth that testicular cancer is a silent killer when in fact; half of patients have testicular pain. He adds there is “no good evidence” of any benefit of self-examination as testicular cancer is so rare and the “chances of discovering something significant […] are minuscule”.
He argues that due to "celebrity exhortations to be 'testicle aware'", the discovery of relatively common swellings and cysts will provoke anything from “mild concern to incapacitating anxiety”. This in turn, leads to unnecessary ultrasound requests and longer waiting times for those who do need further assessment.
Dr Hopcroft suggests that regular testicular self-examination is “illogical and potentially harmful” and the key issue is more about men failing to act on swellings rather than finding them. This, he says, is the message that needs to be conveyed instead. He says, however, that this is “drowned out by the noise from campaigns that are […] turning the nation’s blokes into ball watching neurotics”.
Dr Margaret McCartney, General Practitioner, Glasgow, Scotland
Dr Keith Hopcroft, General Practitioner, Essex, UK
Susan Golaszewski, Which? Press Office, London, UK