The right’s culture war over prostate cancer screening is damaging trust in medicine | Polly Toynbee

7 hours ago 2

If the country seems to be slipping away from reason and trust in science, blame usually falls on modern phenomena such as social media and its fantastical influencers. Or on the US health secretary Robert F Kennedy Jr’s bizarre anti-vaccine, anti-fluoride, anti-evidence lunacy. But campaigns against the UK national screening committee’s decision to limit prostate cancer testing have been run by British bastions of the sort laying claim to “common sense”. They include two Tory ex-prime ministers, David Cameron and Rishi Sunak (who see themselves as sensibles, unlike Boris Johnson and Liz Truss), joined by their Tory/ Reform media, especially the Mail and the Telegraph, plus a host of distinguished campaigners such as Stephen Fry, fount of QI knowledge.

The national screening committee (NSC) has for a long time resisted a call for universal testing of all men for prostate cancer, though it kills 12,000 men a year in the UK. I was on the committee in the 1990s, and it was besieged by demands for screening for prostate cancer and numerous other conditions. These were often refused for unreasonable cost, but this decision is about harm to men, not about money.

This week the new health secretary, James Murray, wisely endorsed the committee’s recommendation that only a small group with a high-risk gene should be regularly tested. In addition, more black men will now be included in the Transform randomised control trial to see whether screening them would reduce deaths from prostate cancer, as they are twice as likely to develop the disease.

The NSC’s chair, the oncologist Prof Sir Mike Richards, praises Murray for rapidly endorsing the committee’s recommendation, undaunted by vigorous campaigning for wider screening. Here is the NSC evidence: for every 1,000 men aged 50-60 screened with a prostate specific antigen (PSA) blood test, one life will be saved. But 12 men will be over-diagnosed and told they have a cancer that would in fact never threaten their lives. They may be overtreated with unnecessary surgery and radiotherapy causing life-altering damage, including permanent incontinence (needing pads to deal with leaking urine) and severe erectile dysfunction.

Richards talks powerfully of how the harms outweigh the benefits for screening beyond the highest-risk men. He tells me that many are so alarmed by being told they have a tumour that they don’t accept advice that regular surveillance will suffice: they panic and demand radical treatment that then harms them. He is not even convinced that one or two lives per 1,000 screened are genuinely saved: those men may have died of something else. He claims: “Lithuania is the only country that has a universal screening programme, but their mortality rate is no better.”

The public, when asked if the NHS should supply something, can usually be relied on to says yes. So when Ipsos asks them for the Daily Mail’s “End Needless Prostate Deaths” campaign, 86% want wider screening for high-risk men.

In a time of poisonous culture wars, this screening decision stirs up racism and misogyny, with critics claiming a “two-tier” screening service. On news that black but not white men will be added to the trial, here’s Zia Yusuf, Reform’s home affairs spokesperson, posting on X this week: “On the day the whole political establishment claims we do not live in a two tier country, they announce this. Note, the NHS makes NO drugs available exclusively to white people.”

Some men’s groups have long protested to the committee that women are favoured with universal breast cancer screening, ignoring what the science says about the very different relative effectiveness of the two tests. And here’s the Mail’s Amanda Platell this week: “This decision on prostate cancer makes men second-class citizens. The news that health boffins advising the government have rejected a call for mass prostate cancer screening sent a shiver down my spine.” (Note that patronising word “boffins”, suggesting science is beyond readers’ understanding and of doubtful common sense.)

When the Telegraph reported on the screening news this week as part of its “Testing Saves Lives” campaign, some comments took up these themes: “This is outrageous. Prostate cancer screening should be available to all men that fall into the vulnerable age group but only those who have lived and worked here for so many years.” “Women have had breast cancer screening for decades and it’s saved many lives. Now screening for men is available and even those at higher risk are being denied it. Equality?” “NHS is now run by women – for women.” “Ration prostate cancer testing? How do you think women would react if breast cancer screening were rationed to the same extent? Outrageous AMB (anti-male bias).”

All this provocation has real consequences. Andrew Wakefield’s discredited MMR-vaccine-causes-autism claim has done lasting damage, as uptake of the vaccine keeps falling. That vaccine hesitancy was worsened by Covid scare-talk. The World Health Organization says 95% of children need to be vaccinated to eradicate measles, but the rate fell to 88.9% last year and the UK lost its measles-free status. FullFact reported last year a rise in false information and a fall in trust.

Prof Bobby Duffy at King’s College London is starting on a major Trust in Science survey for the Wellcome Foundation, observing the rapid collapse in trust in the US since 2016, with a widening gap between Republicans and Democrats (Democrats trust evidence more). Duffy says with the Nordic countries at the high end of the trust scale and the US at the bottom, the UK, he says, is now closer to the US end of the spectrum. These darkening waves of unreason from the hard right should indeed send shivers down the spine.