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Monday morning, off goes the alarm…
… here we go!
Kids, cats, dogs, animals. Clear-up, shower, make the sandwich boxes. Gulp a coffee. Clothes, hair, make-up…
Grab the bag… head for the door.
How long does it take?
Twenty minutes? An hour? I’d guess the average is 45 minutes?
Forty five? Sounds about right and…
... can I tell you something…
… during that forty five minutes, whilst you're getting ready to face the day, a man will end his days… dead from prostate cancer. Yes, one man dies every 45 minutes.
Survival depends on catching it before the silent killer slips into your life… sets up base camp, tiptoes around your system and squeezes the life out of you.
Roughly half of prostate cancers are diagnosed by chance. That was me.
The other half present with symptoms, often at a more advanced and dangerous stage... and too late.
In other words, without organised screening, men are left to rely on luck.
The UK National Screening Committee has said ‘no’, to targeted screening even for the men most at risk…black men and those with a family history.
Their predecessor committees have said no since 1997.
It's hard to see how this latest conclusion is right.
The Committee’s first line of argument is that prostate cancer screening risks ‘overdiagnosis’ and ‘overtreatment.’ An argument that is over-the-hill.
Stuck in the PSA tests of the 1990s… too many false positives, too many biopsies, too many harms caused in the quest to avoid harm.
That world has gone.
Modern risk-based approaches… don’t biopsy everyone with a raised PSA… they’re MRI’d, risk-stratified and the majority left alone.
Sweden, Norway, parts of Germany are doing this. Their data shows what ours would show… target-screen fewer men ‘unnecessarily’, catch more cancers, treat fewer late-stage cases.
Mike Richards (he also chairs the chaotic CQC) headed the committee, (as far as I can tell; eleven people, eight women and no black men?), that dismisses lessons from Sweden.
Apparently, the population there is ‘too different’… code for fewer minority ethnic groups.
There is an irony in that conclusion. The very groups that make England different are the groups at higher risk… black men who have roughly double the incidence and double the mortality.
If Sweden can justify targeted screening with a lower-risk population, how can England justify refusing it in a higher-risk one?
It’s the same inverted logic that clings to the belief, inspecting a hospital will make it safer.
As a prostate cancer survivor no one told me testing and scanning and biopsy was a risk above the routine for any other procedure... coz it's not.
I escaped late-stage prostate cancer but I met those who hadn’t. Believe me, it’s brutal. For them, their families... and the Treasury.
Treatment for advanced disease includes long-term hormone therapy, repeated imaging, radiotherapy, chemotherapy, palliative interventions, end-of-life care.
Early, curative treatment means fewer men requiring complex combinations of drugs and the spiralling costs of modern oncology.
Family history is vital. In medical terms, family history is well accepted as;
‘… first-degree relatives (father, brother, son) with a diagnosis of prostate cancer, sometimes extending to second-degree relatives, grandfather…’
… and as in my case… uncle who died of metastasised prostate cancer ... but I never thought of a test. Only luck saved me. Targeted testing would have caught it, long before.
Risk calculators, guidelines, international screening protocols, Sweden, the US, and NICE, rely on this family definition. No ambiguity.
A targeted screening programme mirroring the risk-stratified approach used in Sweden, might cost ~£225 million annually.
It’s a lot but…
… cut late-stage presentations by even 20% (and the evidence is, it would be exceed that) the savings in avoided late-stage treatment and end-of-life care are also, a lot.
Add to that the value of the life that has been lost in the time it takes you to get going in the morning… the moral picture is unequivocal.
Why the reluctance?
Dunno.
I could be persuaded Richards’ group of outliers might have been influenced by the Treasury?
Screening shifts spending forward.
Prevention requires money now. Savings will arrive after Streeting has gone...
... but it is he who will make the final call.
Science increasingly favours risk-based screening. Everything we need; PSA, MRI, risk-stratification algorithms… all exist.
Screening saves lives but if it can’t be shown to save money by next Tuesday, the system finds a way to say no.
I think Mike Richards’ decision is wrong. If you do, too... you can have your say.
There’s a consultation on his conclusions. Please have a look and give a view.
In the time it’ll take you to read this, drink a coffee, flick through the rest of your emails, get organised, make yer mind up, click the website and give a view...
... another man with prostate cancer will be dead.
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