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November 19, 2011

Wrong in more ways than this

       Men sport wispy moustaches.  I pretend not to notice – it seems kinder.  Then one day “nice tache” pops out – nice in the sense of nasty, but let’s not to be rude – and someone tells me what’s going on.

It’s a men’s health campaign.  Click here.  Encourage us to stop smoking, drink less, take exercise, lose weight, check our balls and undergo screening for bowel and prostate cancer.   They asked me to donate!   I’d rather poke a sharp stick in my eye.

It’s not just the matey tone, “mo bros” for fuck’s sake, and attacking the pleasures of smoking, sloth and gluttony.  That’s standard health police fare – a pleasure to ignore.  When do-gooders advise less salt, I sprinkle on a bit extra.  It annoys my wife and daughters, another bonus.

It’s the screening.  Any well-informed man should run a mile from it.  No way do the benefits outweigh the harm, hassle, and worry. [All data below from the relevant Cochrane reviews]   Bowel cancer screening has been evaluated in four decent trials, one of the best a trial from Nottingham, led in recent years by my colleague John Schofield. It reduces bowel cancer related deaths by about 16%.  Sounds good, but at what cost.

If ten thousand 50-year olds crap on a bit of newspaper and spoon up a sample, three hundred will have a tube up their bum and polyps removed, a couple will have a serious complication, bleeding or perforation, and three bowel cancer deaths will be prevented.  Hmm?

But it’s worse than that – despite the huge numbers in the trials, 320,000, there was no effect  on overall mortality.  No effect.  Relative risk 1. Confidence interval 0.99 – 1.02! That really is no effect. None at all. Zilch. Zero. How many more ways can I put it? This is a dead parrot!

There are three possible explanations – the screening causes extra deaths from some mechanism as yet unknown (this is entirely possible), the men saved from bowel cancer death die of something else pretty soon anyway, or the effect is so small that it is swamped by random variation in other causes of death.  This latter explanation is favoured by screening supporters, and may be correct, but it gives the lie to the claim that preventable bowel cancer is an important public health problem!

Prostate screening is worse. Ten thousand men have a blood test, 1000 get an abnormal result and a biopsy (Don’t ask! They wisely keep quiet about it on, and 400 turn out to have prostate cancer. Then what? A radical operation to remove the gland, or watch and see what happens – survival is the same.  Surgery has a high risk of making you impotent and incontinent, but doing nothing with a cancer growing inside you is hardly conducive to happiness. You’ll envy the “bro” who missed his “Well Man” check-up.  Or maybe not.  Maybe the blood tests, biopsies, operations, anxiety, incontinence and impotence prevent some prostate cancer deaths. Sadly no. Despite a 35% increase in prostate cancer diagnoses, there was no effect on prostate cancer mortality. Relative risk 0.93; 95% CI 0.82-1.04. This means the observed 7% reduction could well have occurred by chance. And just in case you’re feeling optimistic, here’s the all cause mortality. RR 1; 95% CI 0.98-1.02. Sorry guys. Another dead parrot.

We need a campaign encouraging men to get on with their lives and keep away from meddlesome doctors.  I’d put my hands in my pocket for that.  I might even grow a moustache. But it won’t be pretty.

Jim Thornton

3 Comments leave one →
  1. Richard Hart permalink
    November 22, 2011 12:44 pm

    Jim, you have mentioned the results of a couple of studies. Do you even know what research the Prostate Cancer Charity is funding? It’s looking at IMPROVING diagnostic tools and treatments.

  2. November 22, 2011 6:39 pm

    Good point Richard, You’re right we need good quality research. And the Prostate Cancer Charity is commendably reticent about screening’s benefits. Good for them.

    But not so Their health check poster. lists health checks for different age groups. In the 40’s, 50’s, 60’s and 70’s the number one is prostate cancer and number two bowel cancer. I still think Movember is medicalising the worried well.


  1. Surgery for screen-detected prostate cancer «

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