A leading Jewish medical charity has raised concerns about a new national prostate cancer screening programme for “not yet [going] far enough”.
Last week, the UK National Screening Committee (UK NSC) published its final recommendation that PSA screening should be offered every two years to men aged 45 to 61 with a BRCA 2 mutation who have a family history of BRCA-related cancers - prostate, breast, ovarian or pancreatic.
But Jnetics, a charity which works to prevent Jewish genetic disorders (JGDs), said that while the screening programme was “a major step forward that has the potential to save lives”, it should encompass all men with BRCA 2 mutations.
A Jnetics spokesperson told the JC: “Men carrying a BRCA2 mutation remain at significantly increased risk of prostate cancer, regardless of whether they are aware of a relevant family history. Many families have incomplete medical histories, small family structures, adoption, estrangement, or cancers that were never formally diagnosed or discussed.
“We are therefore calling on the NSC to urgently widen eligibility so that all male BRCA2 carriers can access enhanced prostate cancer screening.”
They observed that women with BRCA mutations – who are at high risk of breast and ovarian cancer – were already offered intensive surveillance and risk-reducing options through the NHS, and “men at similarly elevated genetic risk deserve equitable access to preventative care and early diagnosis pathways”.
Men with a BRCA 2 mutation have an up to 35 per cent lifetime risk of developing prostate cancer. In the general population, the risk is 12.5 per cent.
Both BRCA 1 and BRCA 2 mutations are much more common in the Jewish community, with one in 40 Ashkenazi people and one in 140 Sephardi people being carriers, compared to one in 250 of the general population.
Professor Ros Eeles, Professor of Oncogenetics at The Institute of Cancer Research (ICR), London, who sits on the Jnetics science and medical advisory committee, called for the screening to be offered annually up “as cancers were detected in each screening year”.
The professor, who led the IMPACT study at the ICR on targeted prostate cancer screening in men at higher risk, said that cutting the screening off at 61 – rather than 69, as in the IMPACT study - would miss 42 per cent of prostate cancers in those with a BRCA2 mutation.
We hope that there will be an early review of these recommendations in other high-risk groups also, as we have shown in IMPACT that BRCA1 alterations are associated with higher risk disease
She also criticised the decision to take BRCA1 carriers off the national screening programme, following a three-month consultation after the UK NSC released draft recommendations in November.
“We hope that there will be an early review of these recommendations in other high-risk groups also, as we have shown in IMPACT that BRCA1 alterations are associated with higher risk disease,” she said.
Even though the risk of BRCA 1 carriers getting prostate cancer is thought to be the same as the general population, they were “more than three times as likely, compared with non-carriers, to have aggressive prostate cancers that are likely to grow and spread quickly”, according to the Institute for Cancer Research.
UK NSC stated that they had removed BRCA 1 carriers from their final recommendations “after discussions with geneticists using published evidence and risk which concluded that those with a BRCA1 variant are not at a sufficiently elevated risk to suggest that benefits of screening would outweigh the harms”.
They said that the main harms of screening included incontinence and erectile dysfunction (impotence) “following unnecessary biopsy or treatment”, as some tumours were slow growing and would not impact a person’s lifespan.
They also said the PSA blood test was not reliable and that for every 1,000 men aged 50 to 60 screened, up to two lives would be saved, but overdiagnosis would occur in up to 20 men.
UK NSC added that between 7 and 15 per cent of men found not to have raised PSA levels could still have prostate cancer.
Like all cancers, the earlier prostate cancer is identified the greater the opportunity for successful management
In March, Chai Cancer Care, which supports cancer patients and their families reported a 63 per cent increase in prostate cancer appointments over the past five years.
Dr Adrian Tookman, chair of Chai's medical advisory panel, said: “With BRCA gene mutations more common among people of Jewish ancestry, some men in our community face a higher inherited risk, making awareness, informed decision making and early support especially important. Access to testing also matters, particularly as the cost of private testing and screening can be prohibitive for many people.
“Like all cancers, the earlier prostate cancer is identified the greater the opportunity for successful management. Helping people understand their risk and seek advice at the earliest opportunity remains incredibly important.”
The prostate screening programme has also faced criticism from other minority groups, disproportionately affected by prostate cancer. Professor Frank Chinegwundoh, consultant urologist at Barts Health, said: “I am deeply disappointed with the recommendation of the National Screening Committee, particularly in relation to black men who have double the risk of getting prostate cancer. I think men can decide for themselves whether they wish to be screened or not and whether the small risk of potential harm outweighs the benefits. Men should be given the opportunity to be screened rather than the current ad hoc arrangements which disadvantage large segments of the population.”
The UK NSC said it was “hopeful that new evidence, new tests and a better understanding of prostate cancer will support much wider screening in the future”.
The Jewish BRCA Testing Programme will resume later this year. To register your interest in being tested, go to: jewishbrca.org or click here
Symptoms of prostate cancer
Men with early prostate cancer will often have no symptoms because of the way the cancer grows. You’ll usually only get early symptoms if the cancer grows near the tube you urinate through (the urethra) and presses against it, changing the way you urinate (wee). But because prostate cancer usually starts to grow in a different part (usually the outer part) of the prostate, early prostate cancer doesn’t often press on the urethra and cause symptoms.
If prostate cancer breaks out of the prostate – locally advanced prostate cancer - or spreads to other parts of the body – advanced prostate cancer- (it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- blood in the urine or semen
- unexplained weight loss
These symptoms can all be caused by other health problems. But it’s still a good idea to tell your GP about any symptoms so they can find out what’s causing them and make sure you get the right treatment, if you need it.
SOURCE: Prostate Cancer UK
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