From over-testing to over-treatment – exploring pros and cons of screening programmes

  • Posted on 21.02.2017

From over-testing to over-treatment – exploring pros and cons of screening programmes


Denis Horgan

Executive Director, European Alliance for Personalised Medicine


The argument has raged for some time and shows no sign of abating any time soon: screening for diseases, yes or no?

Take the case of prostate cancer screening: Richard Ablin – the author of “The Great Prostate Hoax”, and the man who claims to be the first to have identified PSA (a protein created by the walnut-sized prostate gland that can easily be measured) – maintains that PSA testing can do, and often does, more harm than good. Ablin, of the University of Arizona, has noted that a man’s PSA levels may be high but that doesn’t mean that he has cancer. On the reverse side of the coin, a low PSA level doesn’t necessary mean that a potential patient’s worries are over in this regard.Yet the fact remains that around one-in-three men aged from 40-60 has traces of prostate cancer, and the risk rises with ageing. So all men should be regularly tested, right?

Well, not necessarily… Ablin and others argue that over-testing can very easily lead to over-treatment, including unnecessary invasive surgery to remove the prostate gland. The over-treatment argument has also been used in respect of breast cancer screening, although the figures tend to show that it works very well in a preventative sense and even better in detecting early breast cancer in target age groups.

Yet over-treatment is clearly an issue, with many women (plus those aforementioned men with early ‘signs’ of prostate cancer) simply wanting all traces of the disease, or potential disease, removed right away, regardless of the potential cost to them personally or, indeed, fiscally to society in general. So over-treatment is clearly something that cannot be side-stepped. The counter-arguments – and they are very strong ones – is that our ‘social contract’ has obligations to ensure the highest standards possible regarding the health of citizens and that, fiscally, forewarned is forearmed and can save a great deal of money down the line.

Without doubt, all screening programmes have to be based on gathered evidence of efficacy, cost effectiveness and risk. Any new screening initiative should also factor in education, testing and programme management, as well as other aspects such as quality-assurance measures. Two vital bottom-lines are that access to such screening programmes should be equitable amongst the targeted population, and that benefit can be clearly shown to outweigh any harm.

Coming up very soon is the fifth annual presidency conference organised by the European Alliance for Personalised Medicine (EAPM). The EAPM event will take place in Brussels on 27-28 March, 2017, under the auspices of the Maltese Presidency of the European Union. While the conference will take a close look at lung-cancer screening, its general subject matter will be much broader than that.

Experts from all stakeholder groups in healthcare will be examining the need for more recommendations and guidelines on health and preventative measures across the current 28 Member States, affecting some 500 million EU citizens, while taking into account the counter arguments with respect of population-based screening programmes.

Interestingly, as long ago as December 2003, EU health ministers unanimously adopted a Recommendation on cancer screening, which acknowledged both the significance of the burden of cancer and the evidence for effectiveness of breast, cervical and colorectal cancer screening in reducing the burden of disease. At that point, EU guidelines updated and expanded for breast and cervical cancer screening had already been published by the Commission, while comprehensive European guidelines for quality assurance of colorectal cancer screening were being prepared.

More than 13 years on and incidence and mortality rates of cancers still vary widely across the EU, reflecting a major health burden in various Member States, often splitting large and smaller countries along with richer and poorer nations.

EAPM believes there needs to be concrete actions at the EU and Member State levels, not least because less-than-half of examinations performed as part of screening programmes actually meet with all the stipulations of that now-ageing Recommendation. Organisation-wise, Member States and the EU should look to improve all aspects of screening going forward. Therefore, consistent monitoring of population-based programmes should lead to feedback and modification of methods where the latter is necessary.

Yet there is much to be decided, then implemented. And there is a need for greater efforts, supported by collaboration between Member States and professional, organisational and scientific support for those countries seeking to implement or improve population-based screening programmes. The March conference is aimed at addressing such issues.

To register, please visit the conference page

You can download the agenda on the EAPM website

The comments are closed.