Screening and prostate cancer

1. Screening and prostate cancer Rosalie Schultz CARPA August 2011

2. Screening

3. What is disease screening? High risk Low risk

4. Benefits from disease screening • Early diagnosis so the disease can be treated more effectively • More people cured • Lives saved

5. Harms from disease screening • Inconvenience • Anxiety • Wrong test results • Unnecessary treatment • False reassurance

6. What diseases to screen?

7. What diseases to screen?

8. Disease screening • Disease must have early stage • Suitable test – finds people at risk • Effective treatment for people with disease • Screening program must reduce sickness and death • Benefits must be greater than harms, physical and psychological • Social and ethical issues • Costs should be less than benefits

9. Screening for cancer in Australia Cervical cancer Breast cancer Bowel cancer

10. Cervical cancer screening • All women age 18 to 70 who have ever had sex • 2nd yearly pap smear tests • Detects abnormal cells in cervix (“opening of the baby bag”) • Abnormalities may resolve without treatment • Some abnormalities later become cancer - 10 years • Minor operation can remove abnormalities, prevent cancer • About 65% of Australian women have pap smears

11. Cervical cancer screening

12. Breast cancer screening • Women aged 50 to 69 • Mammography – special x-ray of the breasts • Detects abnormalities that cannot be felt • Small operation can find out if abnormality is cancer • Many cancers detected by screening would never cause sickness – 25-30% • About 10 women are treated for every one who benefits • About 55% of women have mammography

13. Breast cancer screening

14. Bowel cancer screening – 2006-2008 • 50, 55 and 65 year-olds invited to send in specimen (1 000 000 Australians) • 39% had test • 7.5% positive = 29 000 • 5.2% had cancer = 1500 • 41% no cancer or adenoma = 12 000 • Full results awaited

15. Prostate

17. Male deaths from cancer Australia 2007

18. Prostate cancer in Australia

19. Breast and Prostate cancer in Australia

20. Prostate cancer in NT Per 100 000 Territorians, Aged standardised, 1991-2005

21. Death in Australia from prostate cancer 2007

22. Prostate cancer screening? • Slow growing disease • Tests: • PSA (prostate specific antigen) blood test • Digital rectal examination – may find extra cases • Treatment – surgery, radiotherapy, chemotherapy • 40% impotence • 3% incontinence • Number who would benefit 0.1% • Autopsies show prostate cancer in 10-20% of 50 year old men; 40-50% of 70 year old men

28. Prostate cancer screening • Many false positive results • Unpleasant follow-up diagnostic procedures • Aggressive treatments • Disease may never have symptoms • Benefit to few and costs to many • Harmful effects greater than health gain from detecting true cases of prostate cancer • No official screening program • 50% of Australian men have been tested

29. Prostate cancer screening • Prostate cancer screening decreases prostate cancer mortality • Large increase in people diagnosed and treated (overtreatment). • Severe side-effects of treatment • Many men have symptoms from surgery, radiotherapy and chemotherapy • Few men live longer or better • Balance is health loss with increased costs

30. Live long enough to die from prostate cancer Thank you!

31. Male deaths from cancer Australia 2007

32. Causes of Australian male deaths 2007