Cancer screening programme leads to bigger fall in death rates

The expected number of deaths from prostate cancer more than halved in the Tyrol after a programme was introduced to improve early detection and treatment of the disease, according to research published in April issue of the urology journal BJU International.

Nearly 87 per cent of eligible men have been tested at least once since the programme was introduced in 1988. By 2005 cancer deaths had fallen by 54 per cent, compared with 29 per cent for the rest of Austria, which hadn't benefited from the programme.

There is no evidence that trends in the Tyrol and the rest of Austria were significantly different before free testing was introduced.

'Prostate specific antigen (PSA) testing was introduced to the Tyrol in 1988 and since 1993 it has been freely available to all men aged from 45 to 75 and to men under 40 with a family history of the disease' explains lead author Professor Georg Bartsch from the University of Innsbruck, one of the international team of medical experts that makes up the Tyrol Prostate Cancer Screening Group.

'Our findings suggest that the combination of free PSA testing and free treatment for any resulting prostate cancer can lead to significant reductions in death rates. This free treatment normally involved surgical removal of the prostate.

'What was interesting about this study was that so many men came forward for testing after the programme was widely advertised in the print and broadcast media. People living in the Tyrol - one of the nine Federal states that make up Austria - tend to enjoy close proximity to health facilities and be very receptive to preventative medical programmes.'

By 2005, just under 87 per cent of men aged between 45 and 75 living in the region had undergone a PSA test.

'Our study clearly shows that deaths from prostate cancer have declined much more quickly in the Tyrol since 1988, when this programme was introduced, compared with the rest of Austria.

'Before the programme was introduced, prostate cancer death rates in the Tyrol were similar to the rest of the country, but after the programme was launched the death rate in the Tyrol started falling by an average of 7.3 per cent a year, more than twice the 3.2 per cent observed in the rest of Austria.'

The findings also have important implications for age-related prostate cancer deaths, say the researchers, especially as the number of older men is steadily increasing.

'Deaths from prostate cancer in the 80 plus age group have been increasing across Austria, but there has been no evidence of this happening in the Tyrol' says co-author Professor Boyle from the International Agency for Research on Cancer.

'This indicates that the screening programme in the Tyrol is picking up cases of prostate cancer at an earlier stage of the disease, when it can be treated more effectively. This early treatment reduces the risk of the disease coming back later in life and killing the patient when they are older.'

The authors conclude that the introduction of free screening has made an important contribution to reducing prostate cancer death rates in the Tyrol, a region where treatment is freely available to all patients with the disease.

But they acknowledge that there is still controversy surrounding some aspects of screening for prostate cancer that need to be resolved.

These include the effectiveness of PSA testing in all cases, whether aggressive treatment alters the outcome in men with advanced stages of the disease and whether testing and treatment seriously impinge quality of life.

'Our study shows that when widespread PSA testing was introduced to the Tyrol, and people with the disease received free treatment to cure their prostate cancer, the fall in death rates was significantly higher than in the rest of Austria' says Professor Boyle.

'This reduction in death rates is most probably due to the fact that cases of prostate cancer were detected at an earlier stage, when treatment for this disease tends to be more effective.

'However it is important to remember that screening is only the first step in the optimal management of patients with prostate cancer.'