Posts Tagged ‘Health Select Committee inquiry’

PROSTABLOG NZ: It’s almost a year since the first hearings were held by the NZ Parliament’s Health Select Committee inquiry into the early detection and treatment of prostate cancer.

The obvious question now is when will it report back.

Since it published its terms of reference in August last year, the committee has received 33 submissions, four of them from the influential health lobby group, the NZ Guidelines Group, whose last submission was made in December.

This document made it clear that the group – an independent incorporated society originally set up by the government in 1996 – is opposed to population-based PSA screening.

To save one life, up to 41 men could incur significant harm.

It bases this view on its assessment of numerous NZ and international studies, including two large randomised trials (one European, the other American) that were reported last year.

Here are some of the last pages of the group’s December, 2009, submission (RCT = random controlled trial):

This also appears to be the main thrust of submissions on PSA testing from other health authorities (although the Guidelines Group is at pains to stress it is independent from the Ministry of Health).

Another “official” organisation, the National Health Committee, said in its submission (August 26, 2009) that it has seen nothing to change its 2005 advice to the MOH that population-based PSA screening is not an acceptable option.

However, it did favour targeted screening of high-risk groups, such as men with a family history of prostate cancer.

The NHC is aware that since providing its advice in 2005, clinical practice has found
that targeted screening for men at high risk of prostate cancer appears to be useful
and potentially cost effective. These are men who have a family history of prostate
or related cancers.

The Royal NZ College of General Practitioners – presumably speaking on behalf of doctors on the frontline – said in its submission it would go along with the NZ Guidelines Group’s views.

It did make a couple of pleas, however, calling for up-to-date information to hand out to patients, and for treatment to be available to all:

It is important that inequities in access relating to follow up after positive
screening results, and for symptomatic men, are identified and eliminated.

The Cancer Society agreed with the Guidelines Group, and backed this up by quoting from selected organisations in other Western countries.

Most agencies around the world have some form of recommendation that decisions for screening for prostate cancer should be made on an individual basis and in consultation with a medical professional:

The Australian Cancer Council states that:
“In the absence of direct evidence showing a clear benefit of population based screening for prostate cancer, a patient centred approach for individual decisions about testing is recommended. Screening discussions and decisions should always include and take into account, age and other individual risk
factors such as a family history of the disease” (Cancer Council Au 2005).

The American Cancer Society states that:
“The American Cancer Society (ACS) does not recommend routine testing for prostate cancer at this time. ACS believes that doctors should discuss the pros and cons of testing with men so each man can decide if testing is right for him. If a man chooses to be tested, the tests should include a PSA blood test and
DRE (digital rectal exam) yearly, beginning at age 50, for men at average risk who can be expected to live at least 10 more years.” (American Cancer Society 2009).

The UK Cancer Research Council states:
“in the UK, there is no national screening programme for prostate cancer because trials have not yet shown clear evidence that screening will reduce deaths from this disease. Also, many men diagnosed with
prostate cancer have very slowly growing cancers that will never cause any symptoms or problems in their lifetime. So at the moment there is no clear benefit in diagnosing prostate cancer early and it may actually cause harm for some men.”(Cancer Research UK 2009).

Urological Society of Australia and New Zealand states:
“Individual men aged 50 to 70 years with at least a 10 year life expectancy should be able to be screened by annual DRE and PSA testing, after appropriate counselling regarding the potential risks and benefits of investigations and the controversies of treatment.”(Urological Society ANZ 1999).

The majority of submissions – from prominent medical practitioners, prostate cancer lobby groups and patients – urged the committee to recommend PSA testing, if not on a population (all men) screening basis, then at least as a service offered routinely by GPs, without men having to ask (the current MOH policy).

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PROSTABLOG NZ: The ideological debate about prostate cancer screening hasn’t moved along much in New Zealand over the past few years.

I’m judging this from an anecdote a guest speaker at my journalism course told students this week.

An experienced journalist, she said a few years ago she was writing a piece for NZ Listener magazine about PSA screening, and the Ministry of Health would speak to her only on the condition they got to see the resulting article prior to publication.

That usually causes journalists to feel apprehensive, and in this case her fears were realised.

The Ministry people hit the roof over what she wrote (basically, that all men over 50 should be urged to get PSA tests), and made this plain to her editor.

Judging by what I heard from the Ministry team at the Health Select Committee hearing into prostate cancer screening late last year, the official view is still the same: PSA bad.

Speaking of which – I wonder when we’re going to hear anything further from the committee?

Chairman Paul Hutchison made the MOH people promise to deliver their final views last November.

Did they?

Are there more hearings?

When will we see the results?

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PROSTABLOG NZ: This is a very special post – the one thousandth for Prostablog since we launched on April 1, 2009.

It’s special because I’ve reserved it for a brave and resilient couple, Kim and Brian, whose saga with prostate cancer brought tears to the eyes of every person in the Select Committee room at the NZ Parliamentary inquiry into prostate cancer this week.

I’ve never met Kim Cook. We’ve spoken on the phone just a couple of times.

But I know a lot about her from the way she has written for Prostablog over the past winter months.

Her story (entitled John and Mary’s story) is about the struggle she and partner Brian have faced getting treatment for his cancer, which is now advanced.

Kim said she wanted something to come out of their battle: how could she get her message across about the frustrations some prostate patients face with the medical system in NZ?

What better way than to tell the story to the Health Select Committee on the first day of its hearings.

They had already had about 10,000 words from her in a written submission.

What came on Wednesday, via phone teleconference (because Brian was not up to the trip from Auckland to Wellington), was a gritty, emotional but devastatingly precise introduction to their story.

Kim’s voice broke only once, near the end, when she talked of crying herself to sleep most nights.

MPs, reporters, audience, dabbed their eyes at this point.

It was important for the MPs on the committee to hear from this brave woman.

It was a reality check for them, a respite from the mostly dispassionate testimony of medics and bureaucrats.

Kim, Prostablog salutes you.

CLICK HERE to see what Kim said.

FOOTNOTE: prostablog has come a long way from the first days of April, when views were lucky to hit double figures.

Yesterday we had nearly 400 page uploads, the most for a single day. So far.

As I write this, I see that 21,278 people have taken a look since we launched. Probably, it’s a lot more than that, since direct RSS feeds are not recorded.

The most recent indication we have “arrived” was a request from a New York robotic prostatecomy clinic to please put a link to their website on our home page. Happy to oblige.

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JUNE 27: PROSTABLOG NZ: Hopes held by the NZ prostate cancer community that the Government might fund a marketing campaign urging men to get checked took a blow this week.

Hopes were lifted the week before with an announcement the Health Select Committee will inquire into screening, but last Friday this news item appeared in Fairfax media outlets:

THE slashing of millions of dollars from health-promotion programmes targeting cancer, heart disease, diabetes and other long-term conditions will affect frontline services, Government critics warn.

According to Budget documents released by Treasury yesterday, $37 million of ‘‘savings’’ have been docked from 18 health-promotion services, including $2.3m from cancer control, $4.8m from the ‘‘let’s get checked’’ diabetes programme and $3m from the heart disease budget.

Health Minister Tony Ryall said very few of the savings affected any existing services and even in tough economic times, health funding had increased $750m.

Millions of dollars have been spent on extensive TV campaigns aimed at groups in society most at risk of not getting early detection of breast and cervical cancer, heart diseases, diabetes and smoking-related diseases.

These campaigns have focused on Maori and Pacific people, whose poor health statistics justify the special attention

The prostate cancer community has been pushing for a similar effort aimed at men – especially Maori men – but so far the Ministry of Health has said there is no proven benefit from a population-based screening programme.

The Ministry has provided guidelines to GPs, but stepped back from recommending PSA and/or digital examination tests as a matter of course for men with no symptoms of prostate cancer.

The select committee inquiry has already drawn fire, the latest coming from Otago epidemiologist Brian Cox, whose paper in the New Zealand Medical Journal earlier this month rubbished the idea of prostate screening.

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BarryYoungJUNE 22: PROSTABLOG NZ: For many years New Zealand men have refused to accept the lack of a formal screening programme for prostate cancer and have opted for self-requested screening, says NZ Prostate Cancer Foundation president Barry Young (right).

“Without screening programmes, New Zealand men have taken the initiative and established their own,” he says in a statement released to Prostablog NZ. today.

“Nearly 3000 men are diagnosed with prostate cancer every year and about 600 die of it, so you can see the scale of what is happening.

“We are hopeful that the recently announced Health Select Committee inquiry will decide to change this and create a formal prostate cancer screening programme.

“It is every man’s right to know what is happening within his body and to decide for himself whether he should be treated for a disease or not.

“This is particularly the case with prostate cancer, which can be developing within a man’s body without him knowing about it.

“What men have to realise is that in its early stages prostate cancer doesn’t usually exhibit symptoms and when symptoms do occur it is usually too late for effective curative treatment.

“This is why men need to be screened for the disease.  The best chance to cure it is while it is still within the prostate.  Once it is out of the prostate it is usually too late.

“About 10 per cent of men will get prostate cancer and this is bad enough for the average bloke.  But there are some walking time bombs out there, men who have a father or grandfather or brother who has been diagnosed with prostate cancer.

“These men are many times more likely to get the disease.  Depending upon how many of their direct relatives have been diagnosed with prostate cancer, the likelihood that they will get it can climb up beyond 80 per cent.

“Because of this we recommend that men begin annual screening for prostate cancer when they reach 50.  If there is a history of the disease in the family then the screening should start at 40.

Paul Hutchison“We trust that this is the sort of thing that will be looked at during the Health Select Committee inquiry into screening for prostate cancer.  We have already offered the chair of the committee, Dr Paul Hutchison (left), our complete co-operation.”

Mr Young says the decision about whether to be screened for prostate cancer, and then whether to be treated for it, is a matter for each man and his family.

Men should be informed about the various pros and cons associated with the diagnosis and treatment of prostate cancer.

“It is a complicated business and we find that men and their families often need guidance in making a decision, but in the end the decision must be theirs, once they have been fully and accurately informed.

“The Foundation’s mission statement says our role is: ‘to create or enhance an environment to empower men to make informed decisions about the diagnosis and treatment for prostate cancer’.

“I don’t see how anyone can argue with that, and if a screening programme helps with this then we will be all for it.”

For any further information, please call Barry Young, 0274-825-253

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