UPDATE - Issue 03 - June 1999
Minister ignores Expenditure disparity
The first international conference to bring together patients, politicians, medical experts and journalists was held at the end of March at the Royal Institute.
Opening the Conference - Shaping the Future of Prostate Cancer, Dr Jonathan Waxman, chairman of the organising Prostate Cancer Charity said "There is this myth that prostate cancer is a disease of old age and doesn't actually kill people. This is clearly not true."
The Keynote address was given by Baroness Hayman, Parliamentary Under Secretary of State, Department of Health. Despite telling the conference that, as the mother of four boys, she anticipates one or two of them will have prostate trouble during their lifetime, nevertheless she had to deliver the Department of Health's current line that, at present, evidence suggests that prostate cancer does not meet the strict criterion for screening. See panel for a review of these criteria.
The main session, chaired by Dr Tom Stuttaford OBE reviewed the major treatments available today. Superb presentations were given by top surgeon, Mr Tim Christmas, brachytherapy and radiotherapy expert Dr Daniel Ash and oncologist, Dr Stephen Harland. Epidemiologist, Professor Michael Coleman presented the latest research findings which show that cases of prostate cancer have increased by 50 per cent in the last 20 years in men under the age of 60. Survivors from both the UK and the States spoke of their experiences in setting up support networks. A mock debate resulted in an overwhelming majority in favour of prostate screening and members of the press were quizzed too.
Altogether a great success and something to be repeated.
World Health Organisation screening programme criteria
The five criteria which any proposed screening programme should meet are:
1 The condition to be screened for should represent an important public health risk.
No question, prostate cancer represents such a risk.
2 A screening test exists.
Yes, it does. The PSA blood test has been in use for a decade.
3 The test should be safe, acceptable and valid.
Safety and acceptability are no problem. There may be some question about validity. The PSA test does produce some, not many, false positive results. We would argue that these are no more severe a drawback than one finds in other screening programmes such as cervical smear testing and mammography.
4 The screening test should catch the condition early.
Yes it would. Mr Leslie Moffatt, Chairman of the Urological Cancer Services Working Party in Scotland is quoted a saying that screening would gain five years in diagnosis and could save many lives.
5 Following positive screening results, there should be an effective treatment available.
This is the problem criterion as far as the Department of Health is concerned. That and the hidden agenda item, cost. The majority of those who have been diagnosed with prostate cancer and have been treated for it whether by radio-therapy, surgery or hormonal drug therapies are satisfied that they did the right thing in having their condition treated and that their life expectancy is significantly extended as a result. So how can the Department of Health suggest that effective treatments do not exist? Well it does not do quite that but rather points out that some cancers are slow growing, that many men die with the cancer but not of it, that the side effects of all the treatments adversely affect the quality of the patient's life, and that it is currently very difficult to separate the slow growing from the fast growing cancers.