Tag Archives: screening

Yes finger, No finger

4 Dec

One of our favourite sports is commenting on the frequent updated guidelines on prostate cancer testing. Currently there are SEVEN approved sets of guidelines – each of which differs from the others on who and how to test men without symptoms to see if they have cancer (screening).

Today, there is an eighth.

To be fair, the new guidelines are in draft form only, they aim to bring consensus to the process and they are looking at the evidence as carefully as one can.

The most interesting early discussion point is that digital rectal examination (DRE – the finger up the backside) is no longer recommended. This comes as a surprise to those of us who were taught that DRE is free, simple, side effect free and useful. But the best research study suggests that it only picks up a very, very small number of additional cancers and runs the risk on increasing the false positive rate (suggesting men have cancer and need biopsies when in fact there is nothing wrong).

The jury is still out on this and the guidelines are only in draft stage. But at least you can have some expert advice to back you up when you are arguing with your doctor about the merits of DRE!

See http://wiki.cancer.org.au/australia/Guidelines:PSA_Testing/Role_of_digital_rectal_examination for more details.

Statistically it’s much better when it’s exactly the same

28 Jan

It’s very easy to get confused over prostate cancer screening – doctors do it all the time! Currently in Australia there are SEVEN distinct “official” recommendations regarding who should be screened for prostate cancer and how often.  It’s no wonder nobody actually knows what to do.

The big debate of course, is whether prostate cancer screening should be done at all.  Both sides of the debate present statistics, and they can be twisted to defend any position at all.

Here is a great example we came across.

FACT – Survival rates for prostate cancer in America are about 80%.   In England 43%.

FACT – the chance of dying of prostate cancer in America is virtually identical to the chance in England.

OK….how do we reconcile those two completely true, but apparently contradictory, facts?

Here’s how.

Americans love screening and they test lots of people for prostate cancer very often.

And they love treating prostate cancer, no matter how early they find it.

So in America – 136 out of 100,000 men are found each year to have prostate cancer. You can bet nearly all get some sort of treatment.

In England, where many fewer men are screened, only 49 out of 100,000 men are diagnosed.

Now, if all prostate cancers mattered, you would think that the diagnosis in lots of men in England is being missed, that their treatment is being delayed and that they will die as a result.
But the rate of death from prostate cancer in England is 28 per 100,000 men per year.  In America, its trivially better at 26 per 100,000.

In other words, your chance of being TOLD you have prostate cancer in America is more than double in England (136 vs 49).  But your chance of DYING of prostate cancer is basically the same (26 vs 28).

Since more men are diagnosed and treated in America, it looks like regular screening, early diagnosis and aggressive treament is more effective, even when the end-results are the same.

The conclusion?  Research statistics are very dangerous creatures and need to be handled with care.  Talk to your GP about YOUR personal risk.


It’s gotta be done

22 Jan

A new study – done in Victoria, so the findings are really relevant to our patients – shows one-third of patients who are first-degree relatives of someone with bowel cancer have never had a colonoscopy.

Now having a colonoscopy may not be the most fun reason to take a day off work, but finding bowel cancer early – and having a parent or sibling with the disease puts you at significantly increased risk – is genuinely life saving.  The new edition of the practice newsletter (about to go to the printer, but will soon be available at the surgery or at wellonwell.com.au) talks about why Faecal Occult Blood Testing (pooh test) is worthwhile for all adults over fifty. But with a family-history of bowel cancer – colonoscopy is the only way to go.