In medicine we have screening recommendations for the general population. This is based on the disease being screened for; the implications of diagnosis; the available interventions and efficacy; as well as the economic cost of screening.

Well accepted population based screening exists for bowel cancer, breast cancer and cervical cancer. Prostate cancer screening has for years had those in favour and those against screening. The large European based cohort (ESRPC study) found a 20% reduction in prostate cancer mortality from screening and whilst the bigger American study was less emphatic (PLCO study) but there were major flaws. The PSA blood test is known to be a highly sensitive biomarker but has low specificity, which means that it detects most men with prostate cancer, but also identifies men with enlargement, inflammation and infection. This means that further testing is needed such as MRI scan and ultimately biopsy. Critiques of PSA screening is that overdiagnosis of low grade cancers leads to unnecessary radical treatments. Whilst this may have been the case two decades ago, we are now far better at discerning which cancers need treatment and which ones can be monitored.

The group that is interesting is men that choose not to be screened. Some of these maybe due to access and circumstances eg rural men running a business who have less time, inclination and interest in prevention. More often we see these men present at later stages of cancer after they become symptomatic eg blood in urine or non specific fatigue etc. Then there is the group that simply prefer not to know. They have access and they have means but it is not a priority. They would rather not know and prefer to wait till they have a problem.

At the other end of the spectrum is the group of men who are what I call superscreeners. Blood tests twice a year. Annual cardiac Ct scanning and colonoscopy . Annual full body MRI scan and PET scan. Blood tests for unproven parameters and supplementation for unproven reasons. Whilst these can not be recommended widespread at a population level due to the economic costs, individually, after careful consideration they maybe warranted. The downside is incidental findings or false positives that lead to unnecessary interventions.

So what do you do as an individual and how far do you go? That is where it’s important to have a relationship with a family doctor that can explain the pros and cons of the various screening options and what is indicated at each stage of life. Beyond that which is recommended at a population based level, one can then decide whether more in depth evaluation is needed based on your individual risk profile. For example, whilst radiological screening of coronary disease may not be recommended across the board like bowel screening at age 50, if you do have risk factors such as smoking, hypertension or a family history, then it may make sense to have this checked in more detail.

The decision to screen or not, basically comes down to risk. What is the risk of an undiagnosed disease? What are the risks of the diagnostic process? What are the risks of treatment? And what risks are you as an individual willing to tolerate?

Questions that are all worth considering!

As always, wishing you well on your health journey.

Ranjit

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