In coming months, Australian men of a certain age will be encouraged to ask a doctor about whether they should be tested for prostate cancer. Here are a few reasons why they might like to think twice beforehand.
The radio and television community service announcements, titled “Make a Date Mate” and starring actor Michael Caton, are the creation of a Sydney GP (and All-Saints actor), Dr Jeremy Cumpston.
But a general viewer may not realise that this Sydney-based company, has launched an “international marketing campaign” for a prostate cancer test in development.
A general viewer (of either the commercial or the news stories it has generated — for example) also may not realise that the overall thrust of the advertisement is out-of-step with the weight of medical and scientific opinion about prostate cancer screening.
As the Cancer Council Australia noted after the campaign’s launch yesterday: “It remains the case that no major government or public health organisation in the world support or promote systematic prostate cancer screening.”
Not that this is any deterrent for Dr Cumpston, who during a long conversation with Crikey clearly revealed his disdain for those he calls “number crunchers” — the public health and cancer experts who argue there is insufficient evidence to prove that the benefits of prostate cancer screening outweigh harms. Many are awaiting the results of two large overseas trials, due next year.
Dr Cumptson is emphatically a true believer, however, and perhaps this is at least partly a reflection of his own family history — both his father and grandfather had prostate cancer, and he is worried about getting it too. The passion and anger with which he speaks are reminiscent of Wayne Swan’s vitriolic attack some years ago on experts who questioned the screening push.
The advertisement is being promoted under the auspices of the Prostate Cancer Foundation of Australia, which today joins the Crikey Register of influence because of its close connections with industry. The Foundation’s website lists among its many corporate sponsors several companies with a direct interest in promoting the diagnosis and treatment of prostate cancer and related problems.
One of these sponsors, Astra Zeneca, has funded a new DVD produced and sold by the PCFA that features Roger Climpson and GP Dr Con Poulos, that aims “to improve understanding and awareness of prostate cancer in the community”.
Other sponsors include:
- Abbott (whose website recommends prostate cancer screening);
- American Medical Systems which, amongst other things, sells products for two of the most common side effects of prostate surgery, incontinence and impotence;
- Eli Lilly which is also distributing an educational DVD to GPs produced by Dr Cumpston
- Sanofi Aventis.
A leading public health authority on cancer, the University of Sydney’s Professor Bruce Armstrong, has expressed alarm about the Foundation’s ties to industry and urged the public to be wary.
“I feel sad and disappointed that an organisation which, to all intents and purposes, is established to do good allows itself to be compromised in this way,” he told Crikey.
Melbourne oncologist, Dr Ian Haines, raised similar concerns and urged the public to be wary generally of advice coming from patient groups taking industry funding.
“Many of these groups seem to get taken over by vested interests and appear to become a marketing arm of the device or pharmaceutical company,” he said.
“We’re all influenced by who’s funding us so I would urge affected individuals to be very cautious about taking advice from those groups.”
The Foundation’s CEO, Andrew Giles, dismisses such concerns, however, saying pharmaceutical industry funding accounts for less than five per cent of his budget.
“I don’t think they’re giving us anywhere enough money to taint what we’re doing,” he says.
“I think they have a moral obligation to give back some money. Other cancer organisations say they will not take any pharmaceutical money. I run a very poor organisation so we take what we can get.”
For my money, I would advise sending the Caton advertisement “straight to the pool room” (in the vein of Caton’s film The Castle).
For those wanting useful information to guide decisions about prostate cancer screening, check out some of the decision aids listed by the Ottawa Health Research Institute.
Declaration: Melissa Sweet is co-author of a new book which highlights the potential downsides of prostate cancer screening, Ten Questions You Must Ask Your Doctor (Allen & Unwin).
Who else has joined the Crikey Register of Influence? See the latest updates here.
guys! be calm!
thank you melissa the checklists referenced onthe ottawa site are very good. I have PSA tests done but I am in the age group early 50’s have form for that type of cancer on both sides of my family. If you are worried talk to your doctor about risk factors.
wow Pat & Neil… where did you get your medical degrees from? Statistics can be used in many ways but rarely for the greater good. Nice of you to mention that only 45% of doctors have had a PSA test… i suppose i have to go and read the article to see if you have quoted that figure correctly and in context – shame on you: not having the courage to qualify your claim… how many of the doctors in the survey were less than 50 years of age? i don’t expect you felt it relevant to note this, nor where the study was conducted, oh and did i forget to mention the study is 6 years old!!! So what is the evidence to support you claim Pat, that nearly all female doctors have had mammograms and pap smears.. please… back it up with hard data.
Now Neil, i am ashamed. It’s clear you don’t really understand the concept of screening do you… your patient – sitting across from you – sent in by their wives (who have probably had a mammogram or pap smear according to Pat) is not being screened. Screening is a population or community based programme of disease detection. What you do in your practice is case finding. Now this may sound trite or semantic but it is an absolutely critical differentiation. I agree, screening has not been shown to have an impact on prostate cancer survival rates. But case finding is a totally different issue. Are you able to categorically exclude prostate cancer in any man who presents to you? How? I know i can’t. If he is 48 and worried, are you going to send him on his way with an unknown PSA and without doing a rectal exam… what if he has a rectal mass without symptoms or a small high grade prostate cancer that is just palpable. You are not committing him to a death sentence by doing his PSA are you. You are assessing his risk of the disease… just as you do when you convince them to leave without a PSA test form… ignorant and happy… except with information like a PSA, he can be a little better informed himself. Shame on you to deny him that.
I may have to eat humble pie after the two big studies come out but never has there been a screening test searching for a disease quite like prostate cancer. I will declare my conflict of interest early on in that I am a GP. The advocates of prostate screening would have me stick my finger into the worried well as well as request a prostate specific antigen (PSA) blood test. My problem is the science doesn’t back the screening for prostate cancer and I have see lots of old men living with the disease and not dying from it. I also see quite a few men faced with microcancers having major treatments such as radical prostatectomies and radiation of the prostate. Once diagnosed not many people can sit about and do nothing. Ignorance is bliss in this case.
In the past fortnight I have discussed prostate cancer screening half a dozen times with men. By and large they have been sent in by their wives. Most have been quite happy to leave unscreened and most seem to understand the concept of screening.
As far as the rectal exam goes, nobody likes it but nobody refuses it when needed.
I have been on the PSA testing circus due to an infection. After several PSAs and “high” results, biopsy. Negative. More PSAs, another biopsy ( less painful than the first). Negative. By now, my ?Benign Prostatatic Hyperplasia has gotten to a serious point. Had the TURP done. All pathology negative on 32 samples. My surgeon, managing me through this peroid out does not recommend PSA testing. I am in the business (biotech) of biomarker discovery (not for prostate cancer).
So with all that history, I start looking at “prostate specific antigen” – PSA and find – an old test with several manufacturers (is there is difference there already?) “Specific” is loosely used here. What do we have in current practice? A range of PSA test kits from different manufacturers , and a test where a “once off” is potentially very stressful if the result is high. A best it is only useful if a series of tests are done over time. What we need is specific test that looks for a biomarker that is proven to be associated with cancer, not something with that circulates naturally throughout the man’s life. And that’s what we have now, and that’s one reason why there is no consensus of opinion about screening.
As for being lectured to by an over zealous GP and she failing to even explain what the PSA test does is just wrong.
Thanks Melissa & the Cancer Council for reminding us that no major evidence based agency anywhere in the world supports prostate cancer screening. This simple-minded stuff about it all being about embarrassment and not being a “man” is so peurile. The reason why no major agency supports it is because there’s no evidence that it saves lives comapred to men who havenlt been screened: as many have pointed out before, screening finds a lot of cancers that would have never caused trouble and the man would have lived a natural life span. But when they are found, there is a high probability that the medical interventions that then arise WILL cause big trouble in the incontinence and impotence departments.
An interesting fact is that less than half (45%) of male doctors have even had the test themselves (see Knowledge, attitudes and experience associated with testing for prostate cancer: a comparison between male doctors and men in the community. Intern Med J. 2002 May-Jun;32(5-6):215-23.) I bet nearly all female doctors have had mammograms and pap smears, and doctors have the lowest smoking rates of all. Doctors, who can read the evidence, know more than most about what’ screening tests are sensible.