Feeds:
Posts
Comments

Posts Tagged ‘National Screening Advisory Committee’

TonyMAINPROSTABLOG NZ: The NZ parliamentary inquiry into prostate cancer closes off its submissions this Friday…and to mark the occasion, I want to write about a man called Tony.

He’s a mid-50s Kiwi bloke. Friendly, articulate, life-experienced, a bit more adventurous, perhaps, than some.

He and wife Marlene (at right) run an excellent bed and breakfast in Mt Eden, Auckland, under the shadow, almost, of where $300 million of my money is being spent revamping Eden Park for the rugby world cup in 2011.

Tony drove trucks across America for a while, until the mid-2000s. Marlene missed him, so joined up, taking the wheel during daylight. They had a fantastic time.

TonyMAIN2But now they’re back home, with Tony working three jobs as they build up the B & B (left) during the recession.

He runs a disability transport service with his vans, walks people around central Auckland city at night telling them ghost and murder stories, and helps Marlene with the homestay.

By all odds, Tony has a 50% chance of hosting a cancer in his prostate.

He doesn’t know it yet, either way. He hasn’t been checked. He’s been too bloody busy.

But now he’s going to the doc and he’ll endure the finger up his backside and the scratch in his arm.

Why? Because Lin and I stayed with Tony and Marlene last weeked and he got an earful from me about getting checked.

Why am I telling you this?  Because Tony is fairly typical of most of the Kiwi men I know (the ones who haven’t had prostate cancer). They either don’t get tested, get only the PSA, or were tested “once” and think it’ll be fine for a few years.

They are what the Health Select Committee inquiry into prostate cancer screening and testing is about.

Two bitterly opposed protagonists

Anyone who thought NZ’s recent prominent murder trials (Bain, Weatherston, et al) were problematic for their juries, spare a thought for the Health Select Committee.

Not only must it contend with the politics of health care, it also faces two ferociously opposed lobby groups that can each present a compelling case.

On one side will be the NZ prostate community, comprising prostate cancer patients, survivors, some of their medics (GPs, urologists, urology nurses, oncologists, etc), and a vociferous band of patient advocates, the 330-strong Prostate Cancer Foundation.

On the other is the health care bureaucracy, encompassing a heavyweight team of health professionals, managers, advisers, epidemiologists, academics, researchers and various subgroups that include some GPs…and the NZ Cancer Society.

Both will lobby the inquiry with statistics, research, study results, precedents, and on one side, at least, some emotionally gruelling anecdotal evidence.

What will each side say?

The bureaucrats (the Ministry of Health and its pilot fish advisory committees) will say what it has always said: we should not adopt a screening and testing programme like that offered to women for breast and cervical cancer because it will do more harm than good.

Their argument is strong, and is the same one argued by other governments’ medical agencies.

It is this: many men (maybe 50%) will get prostate cancer in their lifetime, but only a few (12% to 16%) will contract a form that has the potential to kill them – and there is, as yet, no way to know (before treatment) which kind a man has got.

They say if there is outright encouragement for all men to be tested, whether they have symptoms or not (most won’t, initially), it will lead to unnecessary treatment.

This would cost the government a lot more as well, some argue, but that’s not a point the bureaucracy will highlight, since it doesn’t sound very humane.

Meantime, leave it to patients to raise such matters with their GPs, then make their own decisions based on facts they glean from consultation and research (ie, Dr Google).

The bureaucrats will say there is good reason to trust GPs to do the right thing.

A survey of nearly 350 general practitioners published in 2003 (GP survey 2003) found 74% would PSA test a 55-year-old man who asked (or presented for an annual check-up), with that number rising to 93% if the man’s family history included prostate or breast cancer.

The prostate community argues that since PSA blood tests became widely available in the 80s there has been significant decline in the number of deaths from prostate cancer, and this could be accelerated if screening and testing were promoted to the whole male population.

They say leaving it up to men to raise prostate testing with their doctors is not good enough.

Some men don’t go to the doctor unless they have to, which is a particular problem with prostate cancer, a devious disease that often shows its face when it’s too late for treatment.

Non-consultation is a factor that may apply particularly to Maori and Pacific Island men: the former have twice the death rate of non-Maori. No statistics are available for PI men, it seems.

The prostate community is concerned that some GPs are confused about their role in the prostate process.

Some refuse to test, some don’t proffer advice unless the patient speaks up first, some offer PSA only, some offer both PSA and digital exam. Some men die as a direct result of such a hit-or-miss system, the PCF says.

The foundation and its medical advisers know many cases of men who discover prostate cancer too late.

These are tragic stories, exemplified by the account being written on this website by Mary about her struggle with the medical profession to get treatment for her husband, John. It’s a heart-breaking tale.

There is some bitterness in this debate.

The prostate community is seen as deeply swayed by the emotional influences of suffering the disease or benefiting from dispensing treatment; the bureaucracy is considered heartless, unduly influenced by statistics, gender-biased, and penny-pinching.

Both sides are gathering their forces as this is written.

The Ministry’s line, probably, is encapsulated in advice it received from its satellite National Screening Advisory Committee this winter, after the committee examined the results of the two large overseas screening studies reported in March.

It recommended the Director General of Health should note that:

a) the benefits of PSA screening for prostate cancer identified in the European trial were small;

b) no benefit of prostate cancer screening was identified in the US trial;

c) both trials identified considerable screening harms related to over-diagnosis and over-treatment;

d) the benefits of PSA screening identified in the European trial were observed using an average screening interval of four years, whereas a screening interval of one to two years is more commonly used in general practice;

e) the utility of prostate screening increases with age;

f) a longer study follow-up period may alter trial results; and

g) a watching brief of these two prostate cancer screening trials should be kept, including similar trials of prostate cancer treatment effectiveness, to inform men about making prostate screening decisions.

There is some inevitability, then, about how this inquiry will proceed.

The Ministry hasn’t changed its stance, and the PCF has grown all the more powerful since it gathered considerable funding from the Movember crusade in 2007.

Which suggests the outcome will be influenced by political expediency. As these things usually are.

It’s not a good time to be appealing to a government that’s busy slashing spending in all sectors.

Read Full Post »

new-zealand-parliamentJULY 20: PROSTABLOG NZ: New Zealanders have until August 21 to make submissions to the world’s only current parliamentary inquiry into prostate cancer screening.

Terms of reference for the inquiry by the Health Select Committee were announced today. The committee seeks:

1.      A summary of the contemporary literature on the subject including, incidence, mortality, groups at risk, testing options (with particular reference to age and family history, treatment and what other countries are doing).

2.    Opinions from –

  • affected and asymptomatic men, their families, patient advocacy groups including the Prostate Cancer Foundation and the National Screening Advisory Committee;
  • specialist clinicians, radiation oncologists, urologists and general practitioners;
  • epidemiologists, and those involved with the Ministry of Health, New Zealand Guidelines Group.

3.    Best methods to promote awareness for early detection and treatment of prostate cancer.

4.    A cost benefit analysis, if appropriate.

READ MORE>

Read Full Post »

PROSTABLOG NZ (April 30):  The Ministry of Health says it will be reviewing the two big, long-term trials in Europe and the US that looked at the effectiveness of prostate testing and screening over about a decade.

“The National Screening Advisory Committee will be reviewing the results of the ERSPC and PLCO trials recently published in the New England Journal of Medicine and at their upcoming quarterly meeting to be held on 18 May 2009 in Wellington,” said the Ministry’s Jennifer Beaulac in a brief statement to Prostablog today.

She is the senior policy analyst, strategy and policy, for the National Screening Unit, Health & Disability National Services Directorate, Ministry of Health.

The statement (requested by Prostablog) comes after advice from the Cancer Society of NZ that it is about to begin a review of its policy statement – formulated in 1999 – on national screening programmes for prostate cancer.

The two overseas studies, which have been long awaited by prostate cancer clinicians, have renewed debate in the US about the effectiveness of the PSA test and other screening methods.

A national screening programme for prostate cancer was rejected by the NZ Government following a Ministry of Health-led review in 2005, and there has been no change in that position since. The Ministry updated –  but did not change – its stance last year after beginning another review in 2006.

The main reason is a fear that more wide-spread screening would lead to greatly increased diagnosis of cancer and the prospect of over-treatment because there is no sure way of knowing whether a tumour poses an immediate threat to a man’s life.

Meantime, testing is available for anyone asking his GP, and government funding is available to pay for tests.

More than half the country’s 50+ males are tested already, and more than 2500 are diagnosed with prostate cancer each year. It is the second biggest cancer killer of NZ men.

More than 30% of Maori men diagnosed with prostate cancer later die, a rate that is twice that for Pakeha men. The suggestion is that Maori men leave going to the doctor for a checkup until too late, and there are arguments that a national screening programme would help overcome the problem.

That proposition may be reflected in the breast and cervical cancer national screening programmes, which promote heavily to Maori and Pacific island audiences, presumably recognising their reluctance to see doctors until it’s too late.

Read Full Post »