GP Margaret McCartney has investigated whether customers of private screening companies fully understand what they let themselves in for. In an article published in bmj.com McCartney asks whether private screening companies’ adverts and ‘personal-looking’ letters offer something that is indeed beneficial to their customers given that promoting these services “contrasts with the stance of the NHS”. Unlike private screening companies, the NHS only introduces screening programs after these programs have undergone a comprehensive review by the UK National Screening Committee (UK NSC).
McCartney’s view is supported by Dr. Anne Mackie, the UK NSC Director of Programs who declares:
“Screening tests should be offered only when there is evidence that their use in asymptomatic populations will produce more benefit than harm.”
Dr. McCartney has referred to a study in the ‘Which?’ magazine, which investigated the quality of information provided to people who contemplate being privately screened for cardiovascular disease, risk of stroke, lung cancer and diabetes. ‘Which?’ wrote they were “concerned about the quality of information given to people making important decisions about whether or not to use them.”
The ‘Which?’ study refers to the Committee on Medical Aspects of Radiation in the Environment (COMARE) report that recommended that private screening clinics are regulated, stating that customers should be made aware of the rates of “false positive and false negative results”.
Both, the BMA and the Academy of Medical Royal Colleges wrote a letter to Andrew Lansley in 2010 in which they shared their concerns and called for improvements with regard to information on false positive and negative results, risks and limitations of screening tests, yet so far no legislation has been issued.
Dr. McCartney raises the question of who is responsible for ensuring balanced advertising and that standards are regulated? Together with several colleagues, McCartney issued a complaint to the General Medical Council and received information that no advertising investigations can be carried out without evidence that doctors “did not fully explain the risk / benefits of the procedures”.
According to Dennis Ager, lead officer for health at the Trading Standards Institute, “inaccurate advertisements can be […] treated more seriously when there is evidence of harm or injury to people”, however, this legislation has yet to be applied to private screening clinics. The Department of Health has asked the Royal Colleges of Radiologists and Physicians to develop guidelines on private clinic’s use of radiation, but so far no publication date has been announced.
Dr McCartney concludes that whilst adverts for private screening continue to “pull people in”, the NHS is left to “sort the fallout”. Keith Hopcroft, a GP in Essex, says that based on evidence, testicular self-examination causes more harm than good.
He argues that using celebrities in order to promote testicular self-examination, like for instance Robbie Williams and the Leicester Tigers rugby team together with the specific message, which states, “any self-respecting bloke should regularly examine his testicles” is based on a “well-meaning whimsy” that can potentially have harmful effects.
Hopcroft says that self-examination may have been derived from the myth that testicular cancer is a silent killer, which is inaccurate as 50% of testicular cancer patients actually experience pain in their testicles. He continues that self-examination provides “no good evidence” of any benefit in view of the rarity of testicular cancer so that “chances of discovering something significant […] are minuscule”.
He warns that “celebrity exhortations to be ‘testicle aware'” could lead people to detect relatively common swellings and cysts, which can provoke anything from “mild concern to incapacitating anxiety“, which subsequently leads to ultrasound requests that are unnecessary, as well as longer waiting times for those who really do need further assessment.
Hopcroft indicates that regular testicular self-examination is “illogical and potentially harmful” as the main issue is more about men failing to act on swellings instead of finding them, which he says, needs to be the message that must be conveyed instead, but this message is “drowned out by the noise from campaigns that are […] turning the nation’s blokes into ball watching neurotics”.
Written by Petra Rattue