Hyping the risk for prostate cancer … to what end?

According to a media release issued by Cancer Research UK a few days ago, “Boys born in 2015 will have almost three times the risk of being diagnosed with prostate cancer at some point during their lives than those born in 1990.”

Apparently, based on the most recent data available, the lifetime risk of a diagnosis of prostate cancer in the UK will rise from 5 percent (1 in 20) for boys born in 1990 to just over 14 percent (1 in 7) for boys born in 2015.

Now, before all of the parents of male children born in England in the past couple of years start to freak out, we should carefully point out that this does not imply either of the following:

  • That children born after 2010 are at massively greater risk of prostate cancer mortality than those born 20 years earlier. (The prostate cancer-specific mortality rate in the UK has actually fallen significantly in recent years — from 28.9 per 100,000 men in 1989-91 to 23.8 per 100,000 in 2008-10. It will probably continue to do so, albeit slowly.)
  • That there is necessarily going to be any need for a threefold increase in the number of men who get treatment for prostate cancer. (In fact most of these “new” cases of prostate cancer will probably never need treatment at all, because they are low-risk cases that, until we had the PSA test, we simply never even diagnosed and men never knew that they had.)

There are two reasons why the incidence of the disease is increasing in the UK — just as it did in America in the 1990s:

  • The PSA test allows us to find prostate cancer much earlier in the course of the disease (so-called “lead time”), before it becomes clinically significant. In the case of prostate cancer that lead time can be anywhere from a few months to 20 years.
  • Men in the UK are living much longer than they used to (after finally realizing that smoking three packs of cigarettes a day and downing beer like there was no tomorrow wasn’t exactly a health-inducing strategy!).

The fact that we can find more of something when we have a new test that shows it is there does not necessarily imply that we always have to do something about it. The trick is to understand that several forms of cancer are rapidly becoming chronic disorders as opposed to (necessarily) debilitating diseases. Many people live with chronic disorders today: high cholesterol levels, depression, psoriasis, arthritis, etc. We live with these disorders for years — but for some of them we barely notice any effect on our lives at all, because we have developed highly effective and really remarkably safe forms of treatment.

Most cases of prostate cancer are rapidly becoming classic forms of chronic cancer. Men diagnosed early with low-risk disease are often going to be able to live out a normal lifespan without any need for treatment at all (if regularly monitored). Indeed it is possible that within a few years we will have relatively mild forms of treatment for low-risk prostate cancer that will further minimize any risk for disease progression over time … and with none of the side effects associated with surgery and radiation therapy or any other form of serious invasive therapy.

Now there are still going to be serious and aggressive forms of prostate cancer that need serious and aggressive treatment. Some cancers are not indolent at all. Hopefully, by the time a boy born in 2015 reaches about 50 (i.e., the age when risk for prostate cancer starts to rise), we will have much better treatments available than we have today even for these forms of prostate cancer. It seems increasingly likely, given the progress of the past 40 years.

So what is this media release from Cancer Research UK really designed to do?

Well, like a lot of media from cancer research centers, the primary goal seems to be to make sure they maintain or increase their sources of research funding. This is by no means a bad thing, but it would be nice if Cancer Research UK and similar organizations found ways to do that without any need to terrify the unwary. The “boy that cried wolf” syndrome is still alive and well.

2 Responses

  1. British TV is showing some very creative ads for prostate cancer awareness right now. … I catch them before, after, and at half-time of Premier League football matches.

  2. I suspect that the ads Rick is referring to are ones that can be seen on this page of the web site of Prostate Cancer UK.

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