MEDICAL screening is one of those issues where getting the scientific facts across is extremely challenging. Common sense suggests that routine screening must be a good thing: what harm could it do to systematically test everybody for diseases such as prostate and breast cancer? But as has been shown repeatedly, routine screening is often, on average, harmful. For every life saved through early diagnosis, many more are blighted by psychological trauma, invasive investigations or unnecessary treatments (see 鈥�How medicine got too good for its own good鈥�). False negatives, meanwhile, can lead people who are actually ill to take no action.
The issue reared its head in the UK last month when comedian and writer that he had recently undergone surgery for prostate cancer. A few days later, broadcaster Bill Turnbull announced that he has advanced prostate cancer.
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Fry was diagnosed after a routine check-up found a high level of prostate specific antigen (PSA) 鈥� an indicator of prostate trouble but not a diagnosis of cancer. Turnbull went to his doctor with symptoms but said he regretted not requesting a test that could have picked up the disease earlier.
Both celebrities encouraged men to get checked out. Fry 鈥� rightly respected for his scientific knowledge and rationality 鈥� said 鈥淚 would urge any of you men of a certain age to think about getting your PSA levels checked鈥�. Turnbull said 鈥淚f one man gets tested who might not otherwise have gone to their doctor, it鈥檚 worthwhile.鈥�
It sounds like a no-brainer, but men really ought to think twice about following this advice, unless they have symptoms of prostate cancer or are acting on the advice of a doctor. Both stories are touching but are of the anecdotal 鈥渋t (would have) worked for me鈥� variety.
鈥淢en should think twice about getting tested for prostate cancer, unless they have symptoms鈥�
The reality is that PSA testing remains a blunt tool. Most prostate cancers aren鈥檛 aggressive so don鈥檛 require treatment; as the old saying goes 鈥渕en usually die with prostate cancer rather than of it鈥�. And yet the majority of men who are diagnosed via a PSA test end up having treatment with a high risk of side effects including erectile dysfunction, urinary incontinence and heart attack.
The largest-ever clinical trial of PSA testing, published last month in the , confirmed that while one-off tests in men with no symptoms do result in higher diagnosis, they don鈥檛 increase survival rates. The UK鈥檚 National 午夜福利1000集合 Service doesn鈥檛 have a national prostate cancer screening programme because .
The message is muddied, however, by the fact that some screening programmes do save lives. This week, former UK health secretary Andrew Lansley revealed that he has bowel cancer and called for improvements to the NHS鈥檚 screening programme for 55-year-olds. In this case, that is the correct response, as .
We wish Fry, Turnbull and Lansley the very best. But famous people, however well respected, ought to be careful about giving health advice, and the rest of us should be even more wary about following it.
This article appeared in print under the headline 鈥淒on鈥檛 screen out the facts鈥�
