Why prostate cancer is expected to be left as the only major cancer without national screening

Prostate cancer is expected to remain the only major cancer not to have a national screening programme under new recommendations from government advisers.

The National Screening Committee, which is made up of doctors and economists, says the harms outweigh the benefits for screening all men in their 50s and 60s.

Instead, the committee will recommend screening only for the one in 260 men who have inherited the BRCA cancer gene.

The big problem? They may not know they have the gene, so they won't be screened.

BRCA is sometimes known as the 'Jolie gene', named after the actress Angelina Jolie, who had a preventative double mastectomy after being told she had the gene and an 87% risk of breast cancer.

The mutated gene also increases the risk of prostate cancer. One in three men with the gene is likely to develop aggressive disease.

But usually men will only know they may have inherited the BRCA gene if their mother or sister has had breast or ovarian cancer at a young age - and the female relative has had gene testing as a result.

However, male relatives may not have been told or understand the implications for them. They may be in the dark, not have BRCA testing themselves, and therefore never come forward for prostate screening.

The PSA blood test, which is the first step in prostate screening, has pitfalls.

Yes, it flags men who may have cancer.

But it doesn't determine whether the cancer is aggressive and life-threatening. So it can lead to some men having treatment that is risky but unnecessary.

The committee wants to wait for clearer evidence before giving the green light.

Its draft recommendations will be put out for public consultation, with charities and campaigners expected to lobby for other high-risk men to be included in screening.

Black men are at twice the risk of prostate cancer. And including men with a close relative who has had prostate, breast or ovarian cancer at a young age would side-step the problems in BRCA testing.

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Men like Olympian Sir Chris Hoy, who has a family risk but was diagnosed only when his prostate cancer was advanced, have made a strong case for targeted screening.

The committee isn't convinced.

But even if the final recommendations don't change when the public consultation is complete, it is Health Secretary Wes Streeting who will make the final decision. And he will be more sensitive to politics.

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