UK Screening Committee Limits Prostate Cancer Tests for BRCA2 Men
The UK National Screening Committee recommended against routine prostate cancer screening for most UK men, but backed two-yearly testing for some men with a BRCA2 variant and a family history of related cancers. The advice could narrow who is offered NHS screening to a few thousand men a year.
Prof Sir Mike Richards said the committee judged PSA-based screening to be "likely to cause more harm than good" for most men. He added: "We do know that screening can reduce deaths from prostate cancer to a small extent, and it does not improve overall survival."
Mike Richards on BRCA2 screening
The committee said men with the BRCA2 gene variant and a family history of certain cancers should be screened every two years between the ages of 45 and 61. Richards said: "That was the only strategy where the UK National Screening Committee had confidence that screening would do more good than harm, and the reason for that is that prostate cancer is much more common in people with the BRCA2 variant, and it tends to be more aggressive."
Its estimate was based on risk levels among 100 men with a BRCA2 variant, of whom between 21 and 35 will develop prostate cancer before age 80. The final recommendation did not include men with a BRCA1 gene variant, even though the draft recommendation in November had included them.
Anneke Lucassen on BRCA1
Anneke Lucassen, professor of genomic medicine and director of the Centre for Personalised Medicine at the Nuffield Department of Medicine, University of Oxford, said earlier studies had "hadn’t been able to clearly separate out" the risks posed by BRCA1 and BRCA2 variants. She said two large recent studies found the prostate cancer risk among people with BRCA1 was "significantly lower".
The committee said overdiagnosis remained high even with MRI scans before biopsy after a positive PSA test. It said the main harms of population screening included incontinence and erectile dysfunction in men who did not need treatment for the disease.
Government review
The committee said there was ongoing uncertainty about whether screening would do more good than harm for other at-risk groups, including black men, and recommended against screening them. The government will consider the committee’s guidance.
