9 November 2007
Media stance on prostate cancer screening flawed
Australian men are exposed to un-balanced and often non-evidence based appeals to seek PSA (prostate specific antigen) testing by the media and other opinion formers
Writing in this month’s edition of the Journal of the Royal Society of Medicine, researchers from the School of Public Health, University of Sydney, argue that in recent years the Australian media has “exposed the public to an imbalanced diet of reportage and commentary that either explicitly or implicitly endorsed population screening for prostate cancer.”
Population screening for this cancer using the PSA test is a highly contentious area of cancer control policy. Most cancer control organisations - including the International Union Against Cancer do not endorse population-based screening. Such bodies argue that the test remains of unproven value in reducing mortality and that its widespread use results in significant levels of avoidable morbidity and reduced quality of life among men who consequently undergo treatment.
In the UK, the NHS Cancer Screening Programme has introduced an informed choice programme, Prostate Cancer Risk Management making PSA testing available on request, but with no recommendation to undergo testing.
The authors report that in Australia, population screening is not supported by the Urological Society of Australia and New Zealand, the Australian Prostate Cancer Collaboration or any Cancer Council. Despite this, there are highly organised campaigns urging men to get tested. The paper highlights the way in which these campaigns have received backing by most elements of the media and also by politicians, celebrities and other opinion-formers. It also indicates how “dissenters” from this view – such as Professor Alan Coates, former chief executive of the Cancer Council of Australia – have been vilified in the press.
The authors conclude that the result of this pro-screening promotion, and the virtual absence of any coverage of views expressing caution about PSA testing, has meant that “it would seem difficult for an average consumer not to believe PSA testing to be the sensible, rational decision, despite the dearth of supporting scientific evidence…”.
Julietta Patnick, Director, NHS Cancer Screening Programmes commented: “There is no current evidence to prove that PSA testing will save lives from prostate cancer. The Programme aims to ensure that anyone who is concerned is given clear and balanced information about the benefits, limitations and risks associated with the PSA test. Current evidence does not yet support population screening for prostate cancer.”Dr Chris Hiley Head of Policy and Research at The Prostate Cancer Charity in the UK said: “While this study only looks at the Australian media, it is alarming to think that we might get similar results in the UK. Many decisions are based on gut
instinct, inclination, what’s least likely to hurt or what friends would do. In the case of prostate cancer, men want something that allows them to take action, making the PSA test appealing. In the absence of a test that has been proven to detect the most threatening cancers early enough for life saving interventions, the evidence forces a great deal of uncertainty on many people who are understandably confused.”
"A matter of faith, not science: analysis of media coverage of prostate cancer screening in Australian news media 2003-2006" is published in the November issue (Vol.100) of the Journal of the Royal Society of Medicine.
JRSM is the flagship journal of the Royal Society of Medicine. It has full editorial independence of the RSM. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.The article is available free at www.jrsm.org.