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Published on: November 2, 2013
More harm than good? The UK National Screening Committee's latest review of prostate cancer screening
Talia Boshari1, Andrew Anderson2, Michael Richards2
1Public Health Specialty Registrar, London, UK.
Abstract:
Prostate cancer is the most common type of cancer in men but there is no national screening programme in the UK or in most other countries. The UK National Screening Committee (UK NSC) is the independent advisory body responsible for providing evidence-based recommendations to ministers in the four UK nations regarding screening programmes. Following the expansion of its remit to include targeted screening (2022) and the publication of new long-term trial data, the UK NSC launched a comprehensive review of prostate cancer screening in 2025. To inform this review, a bespoke economic model was commissioned, drawing on best available evidence and input from clinicians, technical experts, and patient representatives. The model evaluated whole-population screening and targeted strategies for men at higher risk. Based on the modelling study and consultation with stakeholders, the UK NSC recommended against whole-population screening and screening in most targeted groups. The UK NSC has recommended screening for men with a pathogenic BRCA2 variant with a family history of breast, ovarian, pancreatic, or prostate cancer. This was the only group where the UK NSC had confidence that screening would do more good than harm, primarily because prostate cancer tends to be more aggressive in this group. This narrative review describes the process taken by the UK NSC in developing its recommendations and highlights where additional evidence is still needed.
Insights
The UK National Screening Committee (UK NSC) recommends against widespread prostate cancer screening. Screening is advised only for men with a BRCA2 variant and a relevant family history, as this group faces more aggressive disease.
Area of Science:
- Oncology
- Public Health Policy
- Health Economics
Background:
- Prostate cancer is a leading cancer in men, yet lacks a UK national screening program.
- The UK National Screening Committee (UK NSC) reviews evidence for national screening programs.
- Recent data and policy changes prompted a comprehensive review of prostate cancer screening.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of whole-population and targeted prostate cancer screening strategies.
- To inform the UK National Screening Committee's (UK NSC) recommendations on prostate cancer screening.
- To identify specific groups that may benefit from targeted screening.
Main Methods:
- A bespoke economic model was developed using current evidence and expert input.
- The model assessed both universal screening and risk-stratified screening approaches.
- Stakeholder consultations were conducted with clinicians, technical experts, and patient representatives.
Main Results:
- The UK NSC recommended against implementing whole-population prostate cancer screening.
- Screening was also not recommended for most targeted risk groups.
- Screening was recommended for men with a pathogenic BRCA2 variant and a family history of related cancers.
Conclusions:
- Prostate cancer screening offers benefits only in select high-risk populations.
- Men with BRCA2 variants and a family history represent a group where screening is deemed beneficial due to more aggressive cancer presentation.
- Further evidence is required to refine prostate cancer screening guidelines.
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