NHS ‘fund bias’ against men may cost 2,500 lives a year
Sarah-Kate Templeton, Medical Correspondent
DOCTORS have identified a “funding bias” against men within the National Health Service that they believe is costing at least 2,500 lives a year.
Patient groups have accused the government of failing to provide a cheap and simple test for a potentially fatal stomach condition that could save twice as many lives as breast cancer screening and costs a fraction of the price.
They claim that men are “falling behind women” in screening programmes because there is more “political benefit” in offering tests to women.
There are no national screening schemes for men at the moment, while £225m is spent every year testing for women’s cancers.
The Men’s Health Forum wants all men to be screened for abdominal aortic aneurysm, a swelling of the main artery that can burst with fatal results.
More than 4,000 men die from the condition each year, yet it is estimated that more than 50% of these lives could be saved if ultrasound screening were introduced, enabling surgeons to repair the weakened part of the artery before it ruptured.
Screening one man costs £23 and the whole programme would require £8.5m a year in funding.
By contrast, breast cancer screening costs £40 per mammogram and £75m a year for the whole programme in the United Kingdom. According to one forecast, the procedure will be saving 1,250 lives a year by 2010.
Screening for cervical cancer is even more contentious.
Some experts insist that the programme is not cost-effective and that more lives would be saved by spending the money on treating or preventing other diseases. About 1,120 women a year die from the condition.
Alan Scott, a consultant vascular surgeon at St Richard’s hospital, Chichester, and principal investigator of a 2002 study into multi-centre aneurysm screening, said: “It has taken the government a very long time to look at the information and make a decision on screening for abdominal aortic aneurysm, particularly in view of how cost-effective this would be compared with breast screening.”
Others are demanding the introduction of a national prostate cancer screening programme, despite concerns about the reliability of current tests. The disease kills about 10,000 men a year.
The effectiveness of the test used at the moment, the prostate specific antigen (PSA) test, has been questioned because high levels of PSA — a protein produced by prostate cells — can signify benign tumours or infections as well as cancer.
Hope has been raised, however, by a new blood test for prostate cancer developed in America, where far more men undergo the PSA test.
A study published in the journal Cancer Research last month showed that the new early prostate cancer antigen test is highly sensitive and does not confuse other prostate conditions in the way that the PSA test does, making it far more reliable.
Lord Steel, the Liberal Democrat peer, who survived prostate cancer after it was detected early using a PSA test, is among campaigners demanding the introduction of a national screening programme.
He said that if the available test was not reliable enough, more effort should be put into finding a better one.
“I do favour screening for prostate cancer,” said Steel. “It is one of the rare areas where men lag behind women in their medical rights.
“Breast cancer screening has been common for a long time but we do not have adequate prostate screening.
“I was very lucky in that I happened to be caught early, but a lot of people are not and we have an unnecessarily high number of fatalities because there isn’t early screening.
“So far the tests are not wholly reliable but I think that, if all men over 50 had the test I had, more would be diagnosed early.”
David Tulloch, a consultant urologist at Edinburgh Western general hospital, said he did not believe the test for prostate cancer was accurate enough at the moment to introduce a national screening programme. However, breast cancer screening was no more reliable and cervical screening was certainly not cost-effective.
“I would disagree with many of the claims for the validity of breast cancer screening,” he said. “There is a lot of political benefit in breast screening.
“The main reason why we have breast cancer screening and not prostate screening is that breast cancer is highly emotive.
“It is something that intelligent, middle-class women campaign for. The cost of cervical screening, for example, far outweighs the benefits.
“Although I do not think prostate cancer screening is justified at the moment, we should be looking for a test that would allow us to screen.”
Doubts still remain over the efficacy of screening for cervical cancer. Research published in the British Medical Journal in 2003 showed that, in order to save one life from cervical cancer, 1,000 women would need to be screened for 35 years.
Worse, the research suggested that testing might do “more harm than good”. It found that women born after 1960 have a 40% chance of having a smear test labelled abnormal at some point in their lives — with all the anxiety, investigations and treatment that implies — even though the chances of this leading to cancer are minimal.
Another paper, published in the Lancet last summer, however, claimed that cervical screening had prevented up to 4,500 deaths a year.
Professsor Alan Ashworth, director of the Breakthrough Research Centre at the Institute of Cancer Research, said comparing costs with lives was “cold-hearted”.
“We cannot just look at the number of lives saved,” he said. “We cannot compare saving the life of a 75-year-old man with that of a 40-year-old woman. We must also take account of the economic impact of losing a woman who is a mother.”
A spokesman for the Department of Health said: “Research evidence in favour of screening for abdominal aortic aneurysms is strong. Further research is currently underway on a comprehensive implementation programme.”
http://www.timesonline.co.uk/articl...1660077,00.html
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