Reliable screening techniques for men's cancers have yet to be found, writes Michael Kelly
A RECURRING theme that pops up whenever we discuss men's health is that men don't take their health seriously enough.
We are told that we don't visit our doctors as regularly as we should and, as a result, diseases and illnesses go unchecked often until it's too late. It is interesting in this context that there are no screening programmes in Ireland which are accessible to men.
The National Cancer Screening Service's (NCSS) current programmes are exclusively focused on women - BreastCheck, which provides free breast X-rays to women aged 50-64, and CervicalCheck, which will provide free screening for women aged 25-60.
Prostate screening is not available from the NCSS, despite the fact that more cases of prostate cancer are diagnosed each year than breast cancer (2,352 cases of breast cancer and 2,407 cases of prostate cancer in 2005).
It would be easy for men to look at this situation and feel slightly confused - if the powers-that-be want us to engage with the health service, surely it would be worth making a screening programme available for us to engage with?
Why do they not do so? Are men the victims of their notorious apathy towards health? Is the NCSS worried that if it sets up a screening programme for men, no one will show up?
In the case of cancer screening, it would seem that the answer to these questions is more complex than we might think.
In fact, deciding which cancers to screen for is not a gender issue at all, but rather a reflection of the fact that reliable screening techniques have not been found for the cancers which affect men most.
The efficacy of prostate cancer screening for example is highly questionable. Screening is currently based on a blood test which measures the level of prostate specific antigen (PSA) in the blood and it is considered by most experts to be highly unreliable.
A raised PSA level may or may not indicate the presence of prostate cancer while a normal PSA reading does not automatically rule it out.
In addition, the disease itself has a very different profile from other forms of cancer. By the age of 80, about two-thirds of men will have some cancer cells in their prostate, but in only a few will it cause problems. Most men with prostate cancer will die from some other cause rather than the cancer itself. As we know, breast cancer is far less forgiving.
"The evidence currently available is insufficient to recommend a population-based prostrate screening programme," according to a spokeswoman for the NCSS, "because of concerns that it may not improve survival or quality of life and may ultimately cause more harm than good."
Both the Irish College of General Practitioners and the Irish Cancer Society agree with this position.
"It's not fair to say that just because we have breast cancer screening for women we should have prostrate screening for men," says Dr Noel Richardson, director of the IT Carlow Centre for Men's Health Research. "Men need to be aware that the reason we have national screening programmes for women is that they are based on trials which have proved their effectiveness. We are just not there yet with prostate. I would love to see a prostate screening programme in place, but only if it is based on good science."
Based on currently available evidence the NCSS has also ruled out screening for lung cancer, which is the most frequent cause of cancer death among men and women. The Irish Cancer Society believes there is a place for lung cancer screening in high-risk individuals (mainly smokers). "The technology for this type of screening is available in most hospitals and initial studies suggest that it is extremely cost-effective," according to communications manager Jane Curtin.
There is better news for men in the fact that the Government plans to roll out a nationwide colorectal cancer screening programme for men and women (aged 55-74) from 2010. "Screening for colorectal cancer in men and women is the only realistic prospect of introducing cancer screening on a population basis for men at this time," says the chief executive of the NCSS Tony O'Brien.
Many medical professionals believe that broadening health screening initiatives beyond cancer would have a bigger impact in the general population and among men in particular. "Broader health screening would be far more important really," says Richardson. "We know for example that heart disease kills more men than cancer and in any case, most cancers are picked up by GPs rather than from specific cancer screening.
"Catching these illnesses early and focusing on prevention rather than cure would save the Exchequer a lot of money in the long run. If we are serious about it, it would require massive investment from the Government."
Would men avail of these programmes if they were provided? "I think that men would take it up - depending on how it's offered to them," says Richardson. "Given what we know about how uncomfortable men are dealing with the primary care system, the way these things are rolled out is very important. For example, would they be better delivered through the workplace?"
Richardson highlights the success of screening undertaken by the Construction Workers Health Trust (see panel) and at events such as the National Ploughing Championships.
The Government and the main Opposition party are in direct conflict on the issue of broader health screening. Fine Gael's Health spokesman Dr James Reilly has called for free, routine GP screening for men and women.
The party's proposed "National Body Test" would include screening for lung, prostate and colorectal cancer, as well as checks on blood pressure, cholesterol, BMI, lung function, urinalysis, and a Dexa scan for osteoporosis.
"For a relatively small investment now, huge savings could be made in human and financial terms by keeping people healthy, rather than treating them when they get sick later," says Reilly. In 2005, the party estimated that the programme would cost €60 million per annum, but says it is currently in the process of re-costing and expects that figure to increase.
The Department of Health and Children confirmed that it has no plans for national routine screening programmes directed at men. "These tests are available to patients in the primary care setting and are available equally to both men and women," said a spokeswoman. "Health screening services are also being facilitated by more and more employers for their staff."
Health insurers in Ireland offer benefits towards health screening for customers. As part of a pilot screening programme starting this month, VHI will offer 57,000 customers a free, cardiovascular risk and type 2 diabetes screening.