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2.1 Deputy F.J. Hill of St. Martin of the Minister for Health and Social Services regarding the introduction of screening for prostate cancer:
While the Health and Social Services is to be complimented on its breast-screening programme for women, would the Minister advise whether there are any plans to introduce prostate cancer screening for men?
Senator B.E. Shenton (The Minister for Health and Social Services):
I am glad the Deputy has raised this important issue. It is a controversial and a rather complex topic. Prostate cancer is the commonest cancer in men. It would be great if there was a good screening programme and if treatment choices were more clear-cut. Unfortunately there are no tests which are available for screening men who have no symptoms. There is a test called "prostate
specific antigen", P.S.A., but unfortunately it has a 75 per cent false positive rate in asymptomatic
men. When offering any screening test to a population of men with no symptoms, it is important that there are more advantages than disadvantages. The sort of harmful consequences screening can cause include unnecessary operations and needless anxiety, for instance, from a positive result
when it turns out that there is in fact no cancer. We are guided by the U.K.'s (United Kingdom)
National Screening Committee in these matters. This group of national experts keeps all the evidence under constant review and does not recommend a screening programme based on the P.S.A. test. Instead it recommends that men thinking about having a P.S.A. test should first have the opportunity to consider all the pros and cons, including the limitations of the P.S.A. test, before making a personal informed choice whether to go ahead and have it.
The Bailiff :
Minister, I am sorry, your time is expired now. Is there any supplementary question? Deputy of St. Martin?
- The Deputy of St. Martin :
Will the Minister not agree that surely one of the most important aspects in things like breast- screening is trying to identify things before they get too far? Surely would it not make sense to introduce something like prostate cancer testing, if nothing else, just to give those people the assurance that they do not have a problem? That is probably just as great as those people ... it is probably better than being told that it is too late.
Senator B.E. Shenton:
I think as I pointed out in my answer, the problem is there is not a suitable test available at the
moment. The P.S.A. test which is the only one available gives out too many false positives and it
can cause more harm than good to carry the treatment further on someone that does not in fact have the cancer at all.
- Deputy R.G. Le Hérissier of St. Saviour :
If the test being used by people like G.P.s (general practitioner) is apparently potentially misleading, why is the Senator's department not counselling against the use of this test?
Senator B.E. Shenton:
Why are we not counselling? Where there is evidence that there may be prostate cancer or where there has been a history in the family of prostate cancer, or the individual has suffered prostate
cancer in the past, the test is extremely useful and it is in these circumstances that it is used. It is
not used as a general screening for healthy men because it gives off too many false results in this area.
- Senator P.F.C. Ozouf :
Is the Minister suggesting that men over a certain age should not have the test? Because that seems to fly completely in the face of the work done by many notable individuals - many notable Islanders - on the importance of men over a certain age having a test. Is he saying that people over a certain age should not have a test as a general precaution?
Senator B.E. Shenton:
I do not think I mentioned age in my reply at all. I think the Senator is hearing voices. I have not got age in my answer.
- Senator P.F.C. Ozouf :
Is the Minister aware that there is a general view held by a number of individuals and which has been promoted by the cancer awareness charities on prostate cancer testing, that men should go and have a P.S.A. test? Is he saying that they are wrong?
Senator B.E. Shenton:
What I am saying is that you should listen to medical advice and I would rather ask a doctor when I should go for a prostate test than ask a politician.
- Senator J.L. Perchard:
Would the Minister confirm that for every hundred men who show positive P.S.A. results and will therefore have to have a biopsy operation which can be at times very dangerous, only 25 will show the positive signs of prostate cancer and that to undertake a complete screening programme of the male population, this is not specific enough and that while it is prudent to have a P.S.A. test, it is not prudent at this stage, because the results of the tests are so vague that the Minister ...
The Bailiff :
Come to the question, please.
Senator J.L. Perchard:
Would the Minister confirm that I have raised a valid point there, Sir?
Senator B.E. Shenton:
The Senator has raised a very valid point there. [Laughter]
- Deputy R.G. Le Hérissier:
Following the very wise words of that well known sycophant, Senator Perchard, Sir, would the Minister now confirm that it is his department's line that men who are healthy - who think themselves healthy, in itself a questionable issue - should not, as Senator Ozouf has indicated, seek to have a P.S.A. test?
Senator B.E. Shenton:
Informed choice is the best way forward. Any man who wants to have this test can go and see his G.P. and ask about it. But he should only go ahead and have it with his eyes wide open and be aware of all the ins and outs of it and what happens when a P.S.A. test result shows up positive.
- The Deputy of St. Martin :
Could I just ask for confirmation from the Minister, given the concern I think, it is generally expressed by men, not just in this Chamber but outside the Chamber as well, does the Minister not think it might be useful for maybe his Medical Officer of Health to produce a paper on it giving out the pros and cons of having this, if only just to give people reassurance?
Senator B.E. Shenton:
I believe that that is an excellent suggestion by the Deputy and I shall take it up with the Medical Officer of Health.