I was poorly last Monday and I spent
almost the entire day in bed nursing an extreme cough/cold/flu episode. Over the
Christmas and New Year break I had one cold or cough after another, and the last
one, just before returning to work, knocked me off my feet completely. So unusually
for me, I did the sensible thing and stayed off work for the day.
Actually, it’s fairly unusual for
men in general to do the sensible thing when it comes too their health. Susan
Hale and colleagues publishing in the British Journal of Health Psychology,
report that unlike women, men are less likely to consult their GP with health
problems, make less use of general health checks and screening than women and
often seek help for symptoms late in an illness episode, sometimes with fatal consequences.
Interestingly whilst women still
have a higher life expectancy than men, they are more likely to have an illness
for which they received medical treatment than men. This doesn't mean that
women are not as healthy as men – there is no evidence to suggest this is the case.
However, for all kinds of reasons women tend to recognise symptoms much earlier
than men and then act more quickly in seeking help in dealing with these and the illness that might have generated the symptoms. Men either don’t recognise
changes in bodily sensations as being symptoms or ignore the symptoms until such time
as they become publicly revealed.
So I was interested to read of the
new guidance released last week by the National Institute for Health and Care Excellence
(NICE) for prostate cancer Each year, over 37000 men are diagnosed with
prostate cancer and a further 10000 will die from the disease. The new
treatment protocol recommends a monitoring approach (‘watchful waiting’ as it’s
described in the US) for everything apart from high risk localised prostate cancers.
Now don’t get me wrong, I am the first to advocate reducing medical intervention. I'm with Illich in that regard. But is this advice
going to work? I doubt it.
There is nothing pleasant whatsoever
about the treatment or diagnosis of prostate cancer. Treatments can often
result in urinary incontinence and erectile dysfunction. Diagnosis involves a digital
rectal examination (DRE) a biopsy and a blood test (PSA). In a study published
in Oct 2013, 60% of men over the age of 50 hadn't heard of a PSA test. Although the number
of female GPs is growing, it’s still the case that 57% of GPs are men. And as
Susan Hale noted there are issues for many men of another man performing a DRE
on them. Biopsy’s are painful and can lead to long term complications, and the jury
is out on the benefits of PSA.
Indeed in the latest study (2012)
which looked at the two major international studies (the Prostate, Lung,
Colorectal and Ovarian Cancer Screening Trial, and the European Randomised Study
of Screening for Prostate Cancer) concluded that for every 1000 men aged
55-69 who are screened every 1-4 years for a decade: 0-1 deaths from prostate cancer
would be avoided; 100-120 men would have a false positive test result that
leads to a biopsy, and about one third of the men who get a biopsy would experience
problems from the biopsy; 110 men would be diagnosed
with prostate cancer. 50 of these men would have a complication from treatment including
erectile dysfunction (29 men) urinary incontinence (18 men), serious cardiovascular
event (2 men) deep vein thrombosis or pulmonary embolism (1 man), and death due to
treatment (1 man).
I can’t see the NICE advice appealing to many men – however there is an alternative. An MRI scan can
establish with 95% accuracy when a man has got prostate cancer. Scans are cheap
to do (£200) compared to a biopsy (£600). Extensive research has found no evidence
that the magnetic fields and radio waves use during MRI scan pose a risk to the
human body. As a diagnostic procedure it’s no more unpleasant or painful than
spending a day in bed with an extreme cold/cough/flu.episode.
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