COMPASS Research Report | Page 11

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Table 1 : Current cancer screening programs

Source : NICE , EU , CDC

The evidence for mammography effectiveness is split

PSA screening is returning to national programmes despite its inaccuracy

Mammography remains a mainstay of breast cancer screening , but is it the cause of improved outcomes ? The USA , Europe , and UK all recommend mammography screening for breast cancer diagnosis but with slight differences in guidelines for ages and frequency of testing . The evidence behind mammography-based screening is not concrete , with some meta-analyses showing benefits and some showing that mammography leads to more harm . Analysis from Sweden showed mammography led to more deaths than those protected from identifying breast cancer ( Olsen et al . 2005 ). Mammography does have some benefits and does reduce metastatic diagnoses of breast cancer , but is not considered the main reason behind the last decade ’ s improvement in breast cancer mortality . The primary reason behind this improvement is developments in therapeutics and patient management . It has been suggested mammography screening needs to be reconsidered as the mortality benefit is decreasing while the overdiagnosis and radiation exposure remain constant therefore changing the benefit-harm balance . Future breast screening programs need to identify high-risk cancers to improve the benefitharm balance .

PSA screening increases as treatment decreases Prostate cancer is the most common non-cutaneous cancer in men and its incidence increases with age ; in post-mortem studies over half of the men over 90 years old had some form of prostate cancer , but was not associated with mortality ( Bell , Del Mar , Wright , Dickinson , & Glasziou , 2015 ). Prostate cancer survival rate is very high with a 5-year survival of 99 % now for stage 1 , but this is not without its complications . There are high rates of side effects from diagnosis and treatment including sexual and urinary symptoms . Whilst the treatment is moving away from more invasive surgery towards active surveillance for low-risk cancer , screening is moving in the opposite direction . Previously , PSA-based screening in the USA for over 50-year-olds without risk factors stopped after the high false positive rate . The UK and Europe differed in their approach and had no dedicated screening program . Despite this improvement in survival rate and change in treatment approach , the European Commission in 2022 has recommended that PSA screening should be introduced in Europe . This is due to improvements in MRI multiparametric accuracy and the introduction of Gleason grade group risk stratification which they believe will prevent overdiagnosis and treatment . 6 % of UK males already undergo a PSA test every year , and PSA testing is known to cause significant anxiety ( James , et al ., 2022 ) as does any false positive test for cancer . The future of prostate screening could include radiopharmaceutical diagnoses such as those in development by companies such as Telix or different biomarkers from liquid biopsies that need to identify those with cancer and the risk from it .

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