Health
Overdiagnosis of Prostate Cancer May Explain Wide Variations in Incidence Across Europe, Study Finds
A new study published in the British Medical Journal has revealed that overdiagnosis of prostate cancer in Europe could be contributing to significant differences in cancer incidence rates across countries. While incidence rates varied up to 20-fold between nations, mortality rates only fluctuated by about five times, highlighting a potential disparity in how the disease is being diagnosed and treated.
Overdiagnosis occurs when a tumour is detected that would not have caused symptoms or death during an individual’s lifetime, leading to unnecessary treatments that may negatively impact a patient’s quality of life. The study suggests that widespread use of PSA (prostate-specific antigen) testing, particularly through opportunistic screening, may be driving overdiagnosis.
“The results of this study are compatible with large overdiagnosis of prostate cancer occurring as a consequence of opportunistic screening with PSA testing,” said Dr. Salvatore Vaccarella, the study’s lead author and a scientist at the International Agency for Research on Cancer (IARC).
Prostate cancer is a significant health issue in Europe, representing nearly a quarter of new cancer cases among men in 2020, with over 70,000 deaths attributed to the disease that year. The risk of overdiagnosis and subsequent overtreatment is higher for prostate cancer than for other cancers, such as breast, cervical, or colorectal, the study noted.
Most European countries, except Lithuania, which has implemented a wide screening programme since 2006, rely on individual-based decisions for PSA testing rather than population-wide screening. However, the study warned that PSA testing as part of routine healthcare or opportunistic screening is not optimal for reducing population-level impacts.
A 2009 study found that 23% to 42% of men diagnosed through PSA testing would have lived without ever knowing they had prostate cancer, further raising concerns about the screening method. The researchers emphasized that any future implementation of prostate cancer screening must be carefully designed to reduce the harms of overdiagnosis.
“The results of this new study emphasize the importance of carefully designing prostate cancer screening to minimize overdiagnosis, with proper quality assurance and monitoring,” Vaccarella added.
The findings were based on an analysis of data collected from 1980 to 2017 from men aged 35 to 84 across 26 European countries. However, the researchers cautioned that the observational nature of the study means no direct conclusions about cause and effect can be drawn.
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