Why I’m wary of health screening

BY FAR the most difficult conversation I ever had with my father was telling him not to have surgery to remove a slow-growing tumour on his prostate as the chances were his heart disease would see him off long before the cancer could do its worst.

But Dad couldn’t bear to live with the knowledge he had cancer, so he had the operation. The tumour was taken away, but as side-effects he was left incontinent and impotent.

He died two years later of heart disease aged 72, the end of his life blighted by indignities caused by surgery I’m convinced he didn’t need. Twelve years on, I still rue the day my father had the screening test that told him he had cancer in the first place.

Dad’s is a case in point of when medical screening ends up being bad for your health. An example of how the modern preoccupation with wanting to predict our medical futures can lead to over-diagnosis, unnecessary investigations and treatment.

This is what forms the basis of my latest Horizon documentary, which screens tomorrow night and sees me undergo a battery of screening procedures in an attempt to establish how useful is the knowledge they give us.

They range from a simple blood cholesterol test to a high-tech scan of my heart and a cancer-seeking scope inserted into my bowel.

I’m now in my late 50s, and at an age when you really start to worry about your health. None of the men in my immediate family made it beyond 72, the age my father died.

I want to live a fair bit longer and in good health. So, any test that can pick up on what’s lying in wait seems a good idea. But then look at the test my father had, which led to his diagnosis. As part of a routine assessment, he was offered a blood test that measures levels of prostate specific antigen (PSA), a protein produced by the prostate.

Raised levels can indicate cancer and will prompt an oncologist to order further tests and advise surgery if it’s found. But prostate cancer is typically extremely slow growing.

The reality for older men is that most of us will die with prostate cancer, but we won’t actually die from the prostate cancer. The PSA test is

based on research carried out in the Seventies by U.S. urologist Professor Richard Ablin; it was intended as a way of tracking existing cancer, but in the Nineties doctors started using it for screening.

Millions of men had it, and there is no dispute this resulted in lives being saved. But some doctors began to suspect it was detecting thousands of cases that were growing so slowly they would never have caused any harm.

But a Pandora’s Box had been opened. Because if, like my father, the test flags up the disease, it’s very difficult to put that knowledge to one side and hope that you’ll die before the cancer can take hold.

Professor Ablin appears horrified his work had been hijacked and used in this way.

‘The science was pushed too far,’ he told us. ‘People were too fast to biopsy, too fast to treat. In the U.S. alone, some $60 billion has been wasted on over-diagnosis and over treatment.’

he described it as ‘a public health disaster’.

Looking for diseases that may lurk inside us has become big business. In the UK, we spend about £135 million a year on private health tests and around £754 million on NhS screening.

Of course, if you find a lump or have other symptoms of disease, you should always visit your doctor. But if you’re healthy on the outside, is it really worth probing your insides, too?

Getting ahead of symptoms — which, after all, is what screening is all about — means you can often end up frightening people who could have remained in blissful ignorance of conditions that weren’t ever going to trouble them. And having made this programme, I’m not convinced there is anything healthy about that.

HORIZON: Are Health Tests Really a Good Idea, BBC2, Wednesday 8pm.