Is cancer screening always worthwhile?

Whilst catching up with what’s new in other specialities I found an interesting article on prostate cancer screening in the New England Journal of Medicine. The article reports on the outcome of a European study looking at prostate specific antigen (PSA) testing to detect prostate cancer. After 12 years follow up, men screened by 4yearly PSA tests were 21% less likely to die of prostate cancer than unscreened men. Whilst fewer patients died of prostate cancer in the PSA screened group, there was no difference in all cause mortality rates between the screened and unscreened groups.

The study highlights the importance of looking at all the results from a clinical trial and not just the principal outcome measure.

Crudely this means that screening might stop you dying of prostate cancer but will not stop you dying of something else instead.

Despite the high profile celebrity advocates of PSA screening, particularly from the USA, the answer to the question “does PSA screening save lives?” remains uncertain.

New England J Medicine 2012; 366: 981-90.

Simon Radley March 2012