Tuesday, 28 January 2014

A letter to Bill Bailey

Dear Mr Bailey
I’m a fan, but hopefully not in a spooky way. My children have been brought up on Part Troll, Dandelion MInd, your Remarkable Guide to the Orchestra and even your peculiar Birdwatching Bonanza. I’m delighted that, as frontman for Prostate Cancer UK’s Men United campaign, you’re lending your support to fighting prostate cancer. It’s a really worthwhile cause, and better treatments, support and screening tests are desperately needed. 
But I’d like you to think about about a couple of things that Prostate Cancer UK is encouraging you to say. Because the fact is that your advice may hurt more men than it helps.
You’ve been advising men to talk to their doctors about the prospect of prostate cancer – even if they have no risk factors, family history or symptoms. This week’s PCUK campaign was launched with the message that men should “man up” and start the conversation.
With what object? 
You will know that there is currently no effective screening test for prostate cancer – only a very inaccurate one (the PSA test) which leads to unnecessary and harmful biopsies, and unnecessary and harmful prostate surgery. So what happens after men have manned up for the conversation with their GP?
Let’s imagine that the Men United campaign is a huge success: so successful, in fact, that all men over the age of 50 go to their GPs and start talking about their prostate cancer. And let’s say that, as a result of that conversation, all their ultra-keen doctors decide to play things safe and give their patients PSA tests and biopsies to check for prostate cancer. 
What will be the result (apart from a lot of pain and urinating problems caused by the biopsies)? The result will be that third of the men will be found to have prostate cancer. Yes, that is correct. Autopsy studies consistently show that prostate cancer is regularly found in men who die of other causes, who never even knew they had cancer until their dying day. You can see one recent piece of such research here
So one in three men over the age of 50 have prostate cancer. But prostate cancer accounts for just one in 20 deaths. Put the two together, and the campaign to get all men to start addressing prostate cancer doesn’t add up.
If a million of men go to the doctor as the result of your campaign, a few may have their lives saved by early investigation. But the lives of many thousands will be wrecked with impotence, incontinence, pain and anxiety as a result of unnecessary testing and treatments.
That isn’t a good solution.
What we need are better screening techniques, better ways of differentiating the tiger cancers from the pussycats. I know that your profile-raising work will help raise money to do just that, and that’s very good news. But please don’t make out, as Movember and Prostate Cancer UK are fond of doing, that the answer to prostate cancer is to get men to talk to their doctors about getting tested. It creates as many problems as it solves. Maybe one day, when the tools are there to do something useful, but not now.
My second point will have to wait for another day. Thank you for listening.
Simon