The original comments about screening was in relation to gender differences
in attitude to health which might be psycho-social.
John Whittington's general comments are useful, but I hope people ignore his
discouraging remarks about screening, given below.
Many early cases of breast cancer occur through self-referral and Finland
has achieved greater success with cancer survival in having a population
which readily self-refers.
However, men with prostate cancer cannot always self refer at an early
stage. The
disease is often asymptomatic. BUT early diagnosis PSA < 10, does give
opportunity for a "cure", namely conformal radiotherapy, brachyatherapy
and radical prostatectomy. It is a great advantage to be treated early.
Treatment at a later stage PSA say >10 can be problematic. It should be
remembered that the decision to have Radiotherapy would usually preclude
Radical Surgery, but Androgen treatment can be fitted in at any stage but
often fails in advanced cases. The quality of the histology is important
in reaching a treatment decision and survival has been shown statistically
to depend largely upon the stage at which diagnosis occurred.
I give this opinion in spite of the observation that most men die with
prostate cancer than from it. The "Watch and Wait" decision is something
individual patients are free to negotiate with their consultant. References
on this information can be given to those interested.
We would advise any man aged around 50 to ask his GP for a blood test for
PSA and
seek advise if this was higher than 4. The campaign groups are asking for
well-man health tests to include this blood test.
Ray Shapiro
>Returning to the point that Jim raised about screening, as you have said,
>the gender-difference in life expectancy long pre-dates any formal health
>screening (or the ability to do anything about results of screening), so
>clearly cannot be an appreciable part of the explanation. Furthermore,
>there is the sad, but true, fact that the benefits (in terms of survival)
>of the major screening programmes (e.g. breast and cervical cancer) have
>been pretty marginal. They obviously result in some increase in average
>period of 'survival from diagnosis' (since diagnoses are occurring
>earlier), but the average effect on 'age at death' is, to say the least,
>disappointing. It seems that, for many women, early detection of breast
>cancer does not appreciably delay their death, but does extend the period
>during which they 'suffer' from the knowledge that they have the disease -
>so, with presently available treatments, there is certainly scope for
>debate about the value of screeniong.
>
>As for why 'men have not got prostaic cancer screening' (at least, in the
>UK) one of the main reasons is that we haven't got much of a clue as to
>what to do about 'positive screening results', nor whether it would have an
>appreciable impact on survival, or quality of survival.
>
>Moving back even further in the discussion, to the question of what causes
>the gender differences in 'average life expectancy' (from birth), a little
>bit of that is, again, probably a 'statistical quirk', since the increased
>neonatal/ infant mortality in males, and (I believe) the increased level of
>traumatic/ violent deaths in young males, will 'pull down the mean' - so,
>again, I suspect that the median might show less of a gender difference.
>In biological terms, one imagines that a major factor is the fact that
>women are largely protected ('by their hormones'), up to the time of the
>menopause, from the arterial disease (leading to heart attacks and strokes
>etc.) that are major killers in men from middle-age onwards; women have a
>distinctly 'late/slow start' in that disease process. Beyond that, one can
>but speculate. It is tempting to just 'blame genes' - not the least
>because I think (but am not certain) that similar gender differences in
>'life expectancy' are also seen in many other animal species.
>
>Kind Regards,
>
>
>John
>
>----------------------------------------------------------------
>Dr John Whittington, Voice: +44 (0) 1296 730225
>Mediscience Services Fax: +44 (0) 1296 738893
>Twyford Manor, Twyford, E-mail: [log in to unmask]
>Buckingham MK18 4EL, UK [log in to unmask]
>----------------------------------------------------------------
>
>******************************************************
>Please think before you press the 'Reply' button! Note that if you press
>the 'Reply' button your message will go the individual who posted this
message
>not to the list. With many mailers you will have a 'Reply-to-All' button
that
>will send automatically to the list address of <[log in to unmask]>.
The
>Radstats list is set up for public discussion so please be generous with
your
>thoughts and share them us all.
>*******************************************************
******************************************************
Please think before you press the 'Reply' button! Note that if you press
the 'Reply' button your message will go the individual who posted this message
not to the list. With many mailers you will have a 'Reply-to-All' button that
will send automatically to the list address of <[log in to unmask]>. The
Radstats list is set up for public discussion so please be generous with your
thoughts and share them us all.
*******************************************************
|