Screening and prostate cancer Rosalie Schultz CARPA August 2011 Screening What is disease screening? High risk Low risk Benefits from disease screening Early diagnosis so the disease can be treated more effectively More people cured Lives saved Harms from disease screening Inconvenience Anxiety Wrong test results Unnecessary treatment False reassurance What diseases to screen? What diseases to screen? 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 Screening for cancer in Australia Cervical cancer Breast cancer Bowel cancer 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 Cervical cancer screening 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 Breast cancer screening 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 Prostate Male deaths from cancer Australia 2007 Cancer % of all deaths Mean age at death Lung Number of deaths 4700 6.7 72 Prostate 2900 4.2 80 Colon 1300 1.8 73 Pancreas 1200 1.7 71 Rectum 900 1.3 71 Prostate cancer in Australia Breast and Prostate cancer in Australia Prostate cancer in NT Per 100 000 Territorians, Aged standardised, 1991-2005 Death in Australia from prostate cancer 2007 Age group Number of deaths Rate per 100 000 <40 0 0 40-44 45-49 50-54 55-59 3 7 18 55 0.4 0.9 2.6 8.7 60-64 70-74 75-79 142 315 567 26.6 101.1 223.1 80-84 85+ 713 903 413.8 800.9 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 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 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 Live long enough to die from prostate cancer Thank you! Male deaths from cancer Australia 2007 Cancer % of all deaths Mean age at death Lung Number of deaths 4700 6.7 72 Prostate 2900 4.2 80 Colon 1300 1.8 73 Pancreas 1200 1.7 71 Rectum 900 1.3 71 Causes of Australian male deaths 2007 Cause of death Number of deaths Coronary heart 12000 disease Lung cancer 4700 % of deaths Stroke 4500 6.4 Chronic 3000 obstructive lung disease Prostate cancer 2900 4.2 17.2 6.7 4.2