It’s not often that you come across a pledge in the election manifesto that genuinely makes you think ‘WTF?’ but, credit where its due, the Tories have managed exactly that by promising to “support the roll-out of screening programmes for common cancers’.

What screening programmes would that be, exactly?

Britain already has a long established breast cancer screening programme which, as I pointed out only recently, the UK’s existing screening programme is about as optimal as its possible to get given the limitations of the tests used in screening.

Its not perfect, and there are some significant issues in regards to informed consent and the disclosure of the potential risks associated with false positives, but otherwise its as good a programme as you’ll find anywhere in the world.

There’s nothing in the currently available evidence to support making any significant changes, least of all extending the scope of the programme much beyond the extension that’s due to come into effect in the next year or so.

For cervical cancer, the UK also has an established screening programme and although current research evidence is a little more equivocal that you might like, it does appear to show that routine screening has significant benefits for women over 25, but not for women aged between 20 and 24.

As with breast cancer, most of the significant issues that arise in cervical cancer screening relate to the reliability of the tests used in screening, which are generally considered to be weak relative to the tests used in other diagnostic fields.

For collorectal cancer, Britain began the roll out of its national screening programme in 2006, so its really far to early to assess the effectiveness of mass screening. As with the other two cancers for which routine screening is available, what we do already know is that the main limitations that will apply to this new screening programme are related to the effectiveness and reliability of the tests used for screening, which are still being assessed.

When the EU last assessed the progress of its member states in implementing screening programmes for these three common cancers, in 2007, only Finland matched the UK’s success in rolling out national, population-based, screening programmes, putting the UK. The rest of Europe was still playing catch-up.

Are there any new screening programmes in the pipeline?

Other than these three existing screening programmes there are two further types of cancer that could be candidates for mass screening.

The first of these is ovarian cancer and there is currently a trial in progress, called UKCTOCS, which will assess the feasibility of routine screening for women aged between 50 and 74. Thus far, the preliminary results of this trial seem promising although, again, the main hurdle that researchers are facing lies in the limited reliability of current tests.

However, the UKCTOCS trial will not be complete until 2014, so there is no prospect of a national ovarian cancer screening programme in the lifetime of the next parliament.

A smaller trial has recently close that, if successful, could lead to a targetted screening programme for women who have a familiy history which indicates that they are at much higher risk of developing ovarian cancer than most women. This trial has yet release any results or indicate when it will report its finding, so its impossible to say whether it will leading to viable programme or whether that programme will be ready to roll out during the next parliament.

And that leaves us with prostate cancer…

Prostate cancer is the other hypothetical option and it can be screened for, but in most men its a form of cancer that progresses so slowly that men are much more likely to die with it than die of it.

Prostate cancer, if it is found, is also eminently treatable, the downside of which being that the existing treatment options tend to produce some pretty unpleasant side effects and have both mortality and morbidity associated with them. Depending on how its treated, common side effects can include everything from incontinence and impotence to through to a significantly increases risk of diabetes, osteoporosis, heart attacks and strokes. This is for a condition that, although it will develop in 1 in 6 men during their lifetime, will kill only 3 out every 100 men who develop prostate cancer.

Dr Richard J Ablin, the doctor who discovered the PSA test that is used to screen for prostate cancer, has stated the popularity of the test amongst American men ‘has led to a hugely expensive public health disaster’ in an op-ed in the New York Times in which he also gave this stark assessment of the reliability of the test:

…the test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.

So is this all just an empty promise?

Yes. Absolutely.

As far as screening is concerned the UK already has screening programmes in place for the three common types of cancer covered in the Council of the European Union’s 2003 recommendation.

Of the other cancer’s for which a national screening programme is a possibility, one, ovarian cancer, is at least 5-6 years away from producing sufficient trial evidence to verify whether a mass screening programme is even viable.

As for the other candidate, prostate cancer, there’s nothing I could possibly add, at this point, to top Dr Richard Ablin’s assessment of his own discovery:

“I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.”

So I have to ask again, where are these cancer screening programmes that the Tories are planning to support?

About the author
'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
· Other posts by Unity


Story Filed Under: Blog ,Conservative Party ,Health ,Westminster

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1. House Of Twits

   RT @libcon Why the Tory party's promise on cancer-screening is empty http://bit.ly/c82AUR

2. Thetis

   RT @Unity_MoT RT @libcon: Why the Tory party's promise on cancer-screening is empty http://bit.ly/c82AUR

3. Naadir Jeewa

   Reading: Why the Tory party’s promise on cancer-screening is empty: It’s not often that you come across a pledge i… http://bit.ly/apqQfc

4. Liberal Conspiracy

   Why the Tory party's promise on cancer-screening is empty http://bit.ly/c82AUR

5. Unity

   RT @libcon: Why the Tory party's promise on cancer-screening is empty http://bit.ly/c82AUR

6. Chris Paul

   RT @Unity_MoT: RT @libcon: Why the Tory party's promise on cancer-screening is empty http://bit.ly/c82AUR

7. sunny hundal

   @geraldpjclarke Well, it had a lot of messages than just on cancer. But Tory policy on cancer is actually v crap: http://bit.ly/c82AUR

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