Prostate cancer is being 'overdiagnosed' in Europe. Which countries see the biggest differences?
Overdiagnosis of prostate cancer in Europe may be contributing to large differences in incidence between countries, according to a recent study.
There is up to 20-fold variation in incidence rates across countries while mortality only varied by about five times, according to the study published in the British
Overdiagnosis refers to the diagnosis of a tumour that would not otherwise progress to cause symptoms or death in an individual’s lifetime. It can lead to overtreatment and adverse effects that could lower men’s quality of life, the study said.
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"The results of this study are compatible with large overdiagnosis of prostate cancer occurring as a consequence of opportunistic screening with PSA testing," Dr Salvatore Vaccarella, a scientist from the International Agency for Research on Cancer (IARC) and the study’s lead author said in a statement.
PSA refers to the prostate-specific antigen which can be measured with a blood test.
Prostate cancer represented nearly a quarter of new cancer cases among European men in 2020 and was the cause of over 70,000 deaths.
The risk of overdiagnosis and overtreatment is greater when screening for prostate cancer compared to screenings for breast, cervical, and colorectal cancers. Most European countries, except Lithuania since 2006, have opted for an individual-based decision rather than wide screening programmes.
PSA testing can be provided as part of routine healthcare visits, but ondemand and opportunistic screening "are likely to have a less than optimal effect on the population," the study's authors said.
A study from 2009 found that 23 per cent to 42 per cent of men flagged by PSA testing would have lived out their lives without a prostate cancer diagnosis.
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The difference between countries’ incidence rates ranged from 89.6 per 100,000 men in 1985 to 385.8 per 100,000 men in 2007 while the mortality rates across countries ranged from 23.7 per 100 000 men in 1983 to 35.6 per 100 000 men in 2006.
"The results of this new study emphasise the importance for any future implementation of prostate cancer screening to be carefully designed to minimise the harms of overdiagnosis, with careful quality assurance, assessment, and continuous monitoring of benefits and harms at the population level," Vaccarella added.
The results come from the analysis of data from men aged between 35 and 84 across 26 European countries collected from 1980 to 2017.
The researchers highlighted several limitations such as that the analysis refers to different age groups and time periods and said that the results should be interpreted carefully. As it is an observational study, no conclusions about cause and effect can be made.