Why David Cameron’s calling for more cancer screening

0:00Thomas Moore:Coming up, David Cameron's cancer candour. The former PM goes public with his prostate cancer diagnosis and calls for a national screening programme. How does a banana trigger a CIA-backed coup? Do AirPods herald the arrival of a new global order? What do LED lights say about the future of humanity? I'm Ed Conway, and in each episode of my new podcast, Stuff Matters, I take an object, crack it open and reveal the world-shaping forces hidden inside. This is economics told through the things we think we understand. Search Stuff Matters on your podcast app to listen and follow.

0:43Thomas Moore:Four words we never want to hear, but that so many of us will. I'm afraid it's cancer. David Cameron received his diagnosis a year ago, prostate cancer. Thankfully, the treatment he's received has worked, but many are not so lucky. Hence, he is now calling for a targeted screening programme, one focusing on those at greater risk. He's certainly not the only public figure to do so, of course. Cycling legend Sir Chris Hoy received a terminal prostate cancer diagnosis recently and is calling for better screening and treatment, as is former Sky News presenter Dammit Murnahan. To that end, the National Screening Council is meeting later this week to decide whether to recommend that the health secretary moves forward with broader testing.

1:27Thomas Moore:And it's not entirely a no-brainer. There are medics and public health experts who suggest blanket screening could be counterproductive. Our science correspondent is Thomas Moore. Thomas, what more do we know about David Cameron's diagnosis? We know that he had been listening to an interview on the radio with Nick Jones, who's the founder of Soho House. And Samantha, his wife, said, look, I think you should go and get some testing. So he did. And he was optimistic all the way through, so he thought there'd be nothing to it. PSA test, the blood test, for a protein in the blood that can be released by cancer cells and normal cells too in the prostate.

2:06That came back raised, but he then went on and he had an MRI test, a scan, and that too showed there was something there. So he had a biopsy and ultimately he did have treatment. He had something called focal therapy, which is needles and electrodes which just burn away the cancer cells.

2:23Thomas Moore:It doesn't sound terribly pleasant, but of course, at the end of the day, the main thing, David Cameron, as far as we are aware, as far as he is aware, healthy, right? Yes, we understand that he's cancer free, which is very good news indeed. And it is a reminder to all that coming forward for testing and getting treatment early really can be a lifesaver. I mean, prostate cancer. People know cancer. People will have bumped into those. If they haven't had it themselves, then there will be people within their orbit who have had it. But very specifically, prostate cancer. Tell me about it. It is the most common cancer in England, full stop.

2:55The most common male cancer in the UK. It is the only major cancer without a screening test. So 63 ,000 cases in the UK every year. More than 12 ,000 of those will die. and there is a massive north-south divide here. So if you live in London, one in eight men who are diagnosed with prostate cancer will be diagnosed at a stage where it's too late to be cured. If you live in Scotland, it's one in three. One in three? It's a big difference and so much of it is about coming forward in an early stage, getting testing, you're much more likely to be picked up when it is treatable. But over your lifetime, one in eight men are going to be diagnosed with prostate cancer.

3:40If you're in certain risk groups it's much higher.

3:44Thomas Moore:So there are groups that we can identify as at high risk? Yeah there are. So we know that black men are at twice the risk so one in four of those will develop prostate cancer over their lifetime. If your father or brother had prostate cancer you are at two and a half times the risk and you're also at higher risk if your mother or sister had breast or ovarian cancer. And that's because there are some cancer genes which can cause cancer in either sex. Let's talk about the detection of prostate cancer because as with pretty much every form of cancer, you know, cancering it early is key. So how do we find it?

4:21So there has been this long-standing test called the PSA test, prostate, a specific antigen. Now, the antigen is a protein which is released by cells in the prostate, both normal cells and cancer cells. And it's quite normal to have low levels in your blood, so they can detect it, and that increases with age. Now, at a certain threshold, doctors go, OK, so there's something extra going on in the prostate. That could be cancer, but it could be lots of other stuff too. And that's why the specific antigen is a start in diagnosing, but it is not enough on its own.

5:00Thomas Moore:Thomas, let's just be straightforward about this. I think it's worth our time reminding people that the first test that you will have is what? It's a blood test. It is a blood test. You know, it's no more invasive than that. It's a needle in your vein to take a sample of blood. After that, you know, you just follow the process and you're only beginning to go towards a biopsy or even treatment if they feel that there is something to worry about. I think a lot of men are reticent about going to their doctor about prostate issues. Because, let's just say it plainly, we think we're going to get something shoved up our backside.

5:35Yeah, absolutely. A finger up the backside, yeah. That doesn't generally happen these days unless there are other issues that the doctor thinks might be going on. But generally, it's not to detect cancer. There are other ways of doing that. So I think put that to one side. Men also need to get over the embarrassment. Yes, OK, so the prostate is involved in sexual function. It's normal. We've all got bodies. Women have got over so many issues to do with their health And that's part of the reason that they come forward for cancer screening and death rates have fallen. Men need to do that too.

6:05Thomas Moore:So what exactly is David Cameron calling for then? He's calling for targeted screening. And I think we have to be really careful about this. So your risk increases generally over the age of 50. But there are some men, we've talked about these high risk groups. For them, the risk starts to increase above the age of 45. and they're the ones that we're really talking about when talking about targeted screening. So people who are black or they have a family history, Thursday we're expecting a decision from the National Screening Committee. They are the advisors to the Department of Health. So what then happens?

6:41Thomas Moore:If they decide to go forward with this in whatever kind of scale, be it a pilot, be it a kind of widespread rollout, what happens then? Ultimately it ends up on Wes Streeting's desk. As the health secretary, it's his call. There is obviously a money issue. The NHS is pretty stretched, both in money terms, but also resources, the number of people you need to do all these tests. And that's why I think, at first, this would be targeted screening that they go with, just to test things out, see what impact there is on resources, and then in baby steps, as evidence accumulates, roll it out to other men too.

7:17Thomas Moore:Because as things stand, if I go to my GP at the age of 47 and ask for a prostate test, I'm not going to get it, am I? As a white man, no. But anybody who falls into one of these other risk groups, they should be given a screening if they go in and request it. We have this bizarre situation in the NHS where a GP can have a man in front of them who may fall even into a high-risk group, but they cannot offer screening to them. But the man can request it. And that's the important thing here. Ask for PSA screening. Let's just examine the case four. targeted testing in the kind of the general population.

7:57Thomas Moore:I mean, does it all just boil down to the fact if you catch this cancer early enough, survival rates improve? Yeah, pretty much. That's the same with any cancer. And this is the best way we have at the moment. So there was this big European trial. It was 162 ,000 men in the 50s or 60s. And they had screening every four years with blood tests for PSA and that reduced the number of deaths by 13 % over the following two decades. So there is a reduction in the number of deaths but there is a cost to this too and it's not just financial. The test isn't specific enough and that is where we get into big problems.

8:41Not everybody with a normal PSA test is cancer free. So there can be some cancers that are there, even if you have a normal PSA test. But the bigger issue is that even men with a raised PSA may not have a cancer that they need to worry about in their lifetime.

8:59Thomas Moore:What are the signs of prostate cancer? So this is it. In most cases, there are no symptoms. And if you have advanced cancer, then they can cause problems peeing and that kind of stuff. But that's not necessarily due to cancer. It could be other prostate conditions as well. And that's why screening is so essential. My understanding of prostate cancer has always been, it's not necessarily the fastest developing. You can live with it for a very long time. In fact, the majority of people who have prostate cancer die with it, not from it. That's true. But at the moment, when we haven't got a tool that tells us which are the men with the aggressive cancers and which are the men who can afford to watch and wait.

9:41There is a strategy where you'll have regular screening to keep check on what the PSA level is doing or perhaps even start having MRI scans of the prostate, which obviously gives a very clear picture of what's going on inside the organ.

9:56Thomas Moore:But there is, of course, the parallel example when it comes to the breast cancer screening programme. And there, you increase the amount of people that you are testing, the number of false returns on those tests will increase. The reduction in the number of deaths I talked about, 13 % with PSA testing, that's about the same level that breast screening or bowel screening would have. But at the moment, the mammography is much better at determining who needs to worry and who doesn't need to worry. You can go and have targeted biopsies. And this is why there is now this new trial which is being started by Prostate Cancer UK.

10:36They are looking at combining PSA tests with MRI scans. And the two together are much more specific, much more accurate. They can kind of weed out the men who don't need to worry about it. And even if there is something to worry about it, they can target the biopsy needle much more accurately. because a biopsy has a low risk of bleeding or infection. They don't want to do it unnecessarily. And that's why having an MRI scan can be so beneficial.

11:06Thomas Moore:I get why David Cameron is talking about this in the same way Sir Chris Hoy has also talked about prostate cancer. There is only one country in the world right now that has this PSA-based national screening, and it's Lithuania. It feels as if then, as a result, The medical profession isn't shouting from the rooftops for this change to take place. Yes, and they have been criticised. The National Screening Committee, campaigners have accused them of fixed thinking, that they haven't been keeping up with the evidence. The trial I've been talking to you about was released earlier this year. Now, have they built that evidence into their report coming out this week?

11:47It was a large study. many people would say is you know the kind of study that does give the the green light to screening but i suspect that they're going to be very conservative very cautious and they will make these baby steps towards uh screening and that that will be targeted at high risk men first look

12:05Thomas Moore:we've got two rapidly graying men sitting opposite each other so i suppose we should we should talk about our own personal experiences you you've you've been for the test haven't you yeah i have What prompted it? So I guess my age, doing what I do, I'm well aware of the risk increases with age. And of course, there have been the high profile celebrity cases. So Chris Hoy, who was diagnosed at a very advanced stage. And I thought, you know, I can't dodge this any longer. I've got to do it. So I did go to my surgery. The practice nurse took a sample of blood and the results came back a week or two later.

12:40And it was normal.

12:41Thomas Moore:How was the wait? because I'll say this, cancer scares me. Cancer really scares me. And I'm not the right side of 50 for this test, but I have been mulling over for a variety of reasons, you know, getting one myself. I'm one of the lucky people. I'm in a position that I could pay for a test if I wanted it. And I've avoided it, even though I could do it. And yeah, I mean, that weight can't have been brilliant. No, I guess at the back of my mind, it was reassuring to get that all clear. I say all clear. the test showed there was nothing to worry about there may still be stuff going on in my prostate but I don't know because at the moment the NHS doesn't do routine MRI scans for somebody in my situation so I can't be absolutely sure there is no certainty with this and this is the problems with the PSA test but I would still say knowing your score is good because it's not a one-off you can then come back in a few years time even if you're you've got a low or normal level and you will be able to spot whether that PSA level has shot up and that would suggest there's something going on.

13:47Thomas Moore:The fact that the number of people I've heard diagnosed with prostate cancer who have talked about it openly have made reference to their better half, their partner, their wife, whatever, kicking them, kicking them sometimes literally down the street to go to the GP surgery. I do think that is really illustrative of the problem that people have with cancer, particularly men? Yeah, 100%. I think it needs somebody to encourage you in that direction. We can all find excuses. We don't want to find out bad news. I can tell you being diagnosed with cancer is bad, but being diagnosed with advanced cancer is even worse.

14:24Thomas Moore:How do we encourage people to have these conversations? I mean, it's great. I mean, David Cameron coming out and talking about it, I'm certain will have had a positive effect. For sure. All these celebrities, I think they speak to us. And I think any man who is white over 50 should be going to get a test. Any man who is black or has a family history who's over 45 should be going to get a test. GPs have to give them a test. They have to make sure that the patient in front of them understands the pros and the cons. But, you know, I think it's something it's better to know. The thing with this cancer is it is very treatable, isn't it?

15:01It is treatable in its early stages, but too often we hear of men whether the cancer has spread to the bones or the liver and so on, and then it's not good at all. What then is the treatment? So once upon a time, it used to be a surgical procedure. So they'd go in there, they would cut away the cancer. And the problem is that the nerves in there are very delicate and related to sexual function. and there are also the tube which you pee through is also in there. So there is a big problem with quite serious side effects if the operation hasn't gone right. But there are now much, much better treatments.

15:40You can use lasers, you can use ultrasound, you can do other things as well, which are much better at cutting away the cancer but also preserve the nerve and the tube that you pee through. So they're much safer too. And this is why people have been so reticent at using the PSA testing because there was this belief that it wasn't specific enough, wasn't accurate enough, but it also might lead men down this line towards treatment that they did not need and put them at risk of really quite serious side effects. the testing's getting better it's much more specific when you build in mri scans and so on and that means that fewer men are going forward to to having treatment and when you get to that

16:23Thomas Moore:stage the treatment itself is much safer just lastly if someone is listening to this is concerned for whatever reason and wants to get tested straight to the gp make that appointment uh talk to them about the pros and the cons. If you're over 50, over 45, if you fall into the risk groups, you should be offered a PSA test. And that is going to be the first step of just helping dealing with this. You can't sit there worrying about it at home. Go and get the information, get tested, know your number. Thanks, Thomas. And more of his advice is available over on the website. We've also popped a link to the NHS advice page on prostate cancer in the notes attached to the show.

17:06Thomas Moore:The Sky News Daily is back again tomorrow.

17:31Thomas Moore:crack it open and reveal the world-shaping forces hidden inside. This is economics told through the things we think we understand. Search Stuff Matters on your podcast app to listen and follow.