Early detection saves lives. We know that cancers diagnosed at an earlier stage are often easier to treat and are associated with better outcomes. So why do we screen for some cancers but not others? And with new blood tests such as Trucheck™ and Galleri™ making headlines, how do they fit into the picture?
The answer is a little more complex than simply “screen for everything.”
The NHS screening programmes
The NHS offers national screening programmes only when there is good evidence that the benefits outweigh any potential harms. In the UK, routine screening is currently offered for:
- Breast cancer (mammography)
- Bowel cancer (FIT testing)
- Cervical cancer (HPV testing and cervical screening)
More recently, the NHS has begun rolling out a Targeted Lung Health Check programme. Rather than screening everyone, this programme invites people aged 55-74 who have a history of smoking for a lung health assessment and, where appropriate, a low-dose CT scan. It aims to detect lung cancer before symptoms develop in those at highest risk.
These programmes have been carefully evaluated and have been shown to reduce deaths from cancer while keeping the potential harms of screening to an acceptable level.
Why isn’t there a national prostate cancer screening programme?
This is one of the questions we are asked most frequently.
Although prostate cancer is common, the current evidence does not support offering a PSA blood test to every man in the population.
This isn’t simply a UK decision. Most comparable healthcare systems, including much of Europe, Canada and Australia, have taken a similar approach. Rather than routine population screening, they generally recommend informed decision-making and individual risk assessment.
The challenge is that the PSA test is not a cancer test – it is a prostate test. PSA levels can rise for many reasons, including an enlarged prostate, infection, inflammation, recent ejaculation and cycling, as well as prostate cancer.
A raised PSA can therefore lead to further investigations such as MRI scans and prostate biopsies. While these tests are appropriate for many men, screening an entire healthy population would inevitably identify cancers that may never have caused symptoms or shortened life expectancy.
This is known as overdiagnosis.
Some men diagnosed with these low-risk cancers go on to receive surgery or radiotherapy that they may never have needed. Although modern treatments are continually improving, they still carry important risks, including urinary incontinence, erectile dysfunction and bowel problems.
For this reason, national screening committees continue to conclude that the balance of benefit and harm does not currently support routine PSA screening for every man.
That said, PSA testing can still be extremely valuable for the right person. Men with urinary symptoms, a strong family history of prostate cancer, certain ethnic backgrounds (particularly Black men), or those who simply wish to discuss the pros and cons of testing should have an individual conversation with their doctor.
The future of cancer detection
Exciting advances are taking place in the field of multi-cancer early detection (MCED) blood tests.
You may recently have seen headlines about the NHS Galleri™ trial. Although the study did not meet its primary endpoint, it produced several encouraging findings, including detecting more cancers, reducing the number of advanced (Stage IV) cancers and identifying cancers for which there is currently no routine screening programme. The results reinforce the exciting potential of this rapidly developing area of medicine, while also highlighting that more research is still needed before these tests could replace established screening programmes.
At Montpellier Medical, we offer Trucheck™, another multi-cancer early detection blood test. While it uses different technology and should not be considered directly equivalent to Galleri™, it shares the same ambition: helping to identify certain cancers before symptoms develop. Like all screening tests, it has strengths and limitations and is not suitable for everyone.
Screening is only one part of staying healthy
Cancer screening is most effective when it is used alongside a proactive approach to health. That means attending your NHS screening appointments when invited, being aware of any new or persistent symptoms, maintaining a healthy lifestyle and seeking medical advice if something doesn’t feel right.
At Montpellier Medical, we believe in personalised, evidence-based preventative healthcare. Whether that’s discussing your eligibility for NHS screening, assessing your individual cancer risk, arranging appropriate investigations or considering newer technologies such as Trucheck™, our aim is to help you make informed decisions about your health—not simply to offer more tests.
If you’d like to discuss your individual cancer screening options, we’d be happy to help.