‘How do the data on mammography screening compare with data on prostate cancer screening by prostate specific antigen, which is currently not encouraged in the United Kingdom and other countries owing to its small effect on mortality and large risk of overdiagnosis?’ (www.screening.nhs.uk/prostatecancer)
The question is raised by Mette Kalager, Hans-Olov Adami, and Michael Bretthauer in their recent bmj editorial which discusses the paper by Miller and colleagues on their Canadian study (a 25 year follow up of breast cancer incidence and mortality) because the UK National Screening Committee recommends mammography screening for breast cancer – but not prostate specific antigen screening for prostate cancer – and yet it states that the “aim is to only implement programs that do more good than harm and that the informed choice is a guided principle of screening” (www.screening.nhs.uk/screening).
They argue that the scientific rationale to recommend screening or not ‘does not differ noticeably between breast and prostate cancer’ and add ‘political pressure and beliefs might have a role’.
BMJ Editorial – Too Much Mammography BMJ 2014;348:g1403
A neatly restrained argument posing a reasonable question since breast screening with mammography has been undoubtedly been shown to cause more harm than good (Independent Review – Marmot Report) – and that so-called ‘informed choice’ has been sadly lacking due to screening information being heavily biased in favour of screening; indeed the whole programme, from unsolicited invitation, to problems encountered when trying to ‘opt out’ of screening can hardly be described as offering genuine informed choice.
The Canadian study provides yet more robust information for the current Parliamentary Inquiry into screening programmes.