- Sir Steve McQueen: How can the choice of not providing prostate cancer screenings for Black men be taken by a panel with absolutely no representation from the Black community?
It was certainly a courageous remark delivered by the chairperson of Britain's National Screening Committee during a live broadcast on national radio last November.
I have not mentioned this publicly before, I have indeed suffered from prostate issues cancer "me, so I am aware of what it entails," said consultant oncologist Professor Sir Mike Richards. BBC 's Today Programme.
Following his symptoms, he mentioned that he underwent a PSA blood test, which is designed to detect a possible indicator of the condition, "and based on that, I received my diagnosis."
To finish the tale," he continued, "I underwent removal of my prostate.
Following his diagnosis, Sir Mike — the ex-government cancer advisor — has unfortunately become part of an all-too-common group. Prostate cancer is the most prevalent form of cancer in the UK, affecting around 63,000 people annually and causing approximately 12,000 fatalities. Other notable individuals who have been affected include former England footballer John Barnes and a previous prime minister. David Cameron .
Six-times Olympic cycling champion Chris Hoy Was found to have stage four prostate cancer in September 2023 and learned that it had metastasized to his bones and was incurable in October 2024. And last month, Jeremy Clarkson it was disclosed that he has also been found to have an aggressive type of the illness.
However, although Sir Mike rightfully received recognition for openly discussing his diagnosis and therapy, the remainder of the interview proved to be a major letdown for advocates fighting against prostate cancer.
A senior doctor was supporting a choice made by the UK National Screening Committee (UKNSC) to decline a significant screening initiative for the condition—effectively preventing numerous patients from accessing the therapy he had undergone.
According to the committee's last suggestion, published in May, only males between the ages of 45 and 61 possessing a specific genetic alteration along with a familial background of breast, ovarian, pancreatic, or prostate cancer would be eligible — indicating that as few as 1,500 individuals could be selected for testing.
Activists who had advocated for a more extensive initiative—originally focused on high-risk individuals, like Black men, those with a family history of the condition, or particular gene alterations—expressed that the choice was a "deeply disappointing" move and described it as "a significant setback," cautioning that men could be "sentenced to an unnecessary demise."
However, it's not really unexpected that the committee reached its decision when considering the perspectives of its members—and the strange shortcomings in their collective expertise.
It brings up profoundly disturbing issues regarding the individual selected to decide something so significant, which can determine whether someone lives or dies.
The UK National Screening Committee is an autonomous body monitored by the Department of Health and Social Care, providing advice to ministers and the NHS regarding health screening initiatives, such as initiating, discontinuing, or modifying programs.
Surprisingly, the 13-member panel responsible for one of the most significant choices regarding prostate cancer in British history includes none of the urologists, the medical professionals who identify and manage this condition.
Numerous specialized urologists are, quite rightly, highly skeptical about the composition of the committee. Chris Booth, a former consulting urologist and creator of the men’s health organization Chaps, stated that this was a crucial factor in his description of its "unfathomable" and "ridiculous" choice not to extend screening, which he cautioned will result in loss of life.
The absence of practical experience caused the committee's stance to be based on 'outdated, seriously defective' studies.
Mr. Booth stated that PSA testing served as an "affordable and efficient" method for identifying men who might require additional evaluation, which could be paired with contemporary MRI scans capable of providing a "conclusive" diagnosis.
The UKNSC, which convenes three times annually and reports to the four senior medical officials from the United Kingdom, adheres to several core guidelines when deciding whether to endorse screening—or refrain from doing so. Among these criteria are an accurate testing method and viable treatment options, along with proof that screening offers "greater benefits than risks within a feasible cost."
It fulfills the criterion of "greater benefit than harm," which seems to underlie the UKNSC's choice to decline a significant prostate cancer screening initiative.
The panel has stated that PSA blood tests may not always be reliable, noting that numerous prostate cancers develop so gradually they do not lead to issues or premature death. It mentioned that treating such cases could expose men to avoidable risks like erectile dysfunction and urinary incontinence, suggesting that screening might result in more harm than benefit.
The concept of "more harm than good" is frequently cited by the UKNSC, making it seem almost like a spiritual chant.
A new post on their website emphasized this viewpoint. It stated: "Screening is among the strongest, yet possibly damaging, measures in public health."
It entails conducting examinations on many individuals who appear healthy—most of whom will not end up developing the disease under consideration.
Since screening impacts whole communities, the level of proof required to support it is greater compared to most other medical treatments." It further stated: "Screening should demonstrate that it provides more benefits than risks overall, rather than only for those who might gain from early detection.
The blog was authored by Katy Town, who operates under Anne Mackie, the UKNSC Director of Programmes, responsible for offering specialized and administrative assistance to the committee that eventually formulates the recommendations.
Since April 2013, Professor Mackie has frequently come across as someone strongly advocating for the dangers associated with screening programs.
During an interview with the Times in April 2015, she indicated a notable departure from the typical NHS stance that initial screenings were generally advantageous. She cautioned that—although they offered benefits overall—some individuals undergoing tests for breast, colon, and cervical cancers could experience harm due to the screening process.
"Assisting individuals in realizing that discovering certain things [like cancer] doesn't always have positive outcomes is extremely beneficial," she stated.
I strongly believe that when an individual receives an offer from either the NHS or the private industry, they should think, 'I wonder if I truly need this.'
A few months later, Professor Mackie revisited this topic through a blog post on the committee's website titled: "Why refusing screening may have its advantages."
"Introducing a screening program not backed by research would squander public funds that could be more effectively used elsewhere," she wrote.
It may also harm large groups of individuals by causing unwarranted worry, misleading comfort, or prompting them to undergo therapies they aren’t required to take. In some cases, such treatments might lead to uncomfortable or harmful adverse reactions.
In another blog entry from 2019 titled "Don't allow good intentions to weaken the foundations of population screening," she emphasized that "screening should rely on strong scientific proof of its general advantage for the community," rather than "personal views from specific doctors, administrators, and officials."
In a 2024 address, she stated, "every type of screening causes some level of damage," and noted that "earlier identification isn’t always beneficial... at times, it’s preferable to delay," as failing to do so could lead to "overburdening the system with individuals who aren't actually sick."
It's a perspective strongly supported by several members of the committee.
During earlier NHS evaluations, Chairman Sir Mike stated that "England can and should be proud" of its screening initiatives, which are credited with saving approximately "10,000 lives annually."
However, when it came to prostate cancer testing, he let down advocates by stating that the committee was "confident" that a very limited set of guidelines for screening was suitable.
A different committee member, clinical genetics advisor Anneke Lucassen, explained in 2024 how "the media and governmental reports can often feature optimistic yet sometimes unrealistic statements."
She stated, "I believe the UKNSC excels at staying true to its fundamental belief that screenings must provide greater benefits than risks. That’s crucial."
Another committee member, Chris Hyde—a former medical professional who once worked in hospitals and currently serves as a professor of public health at Exeter University—has stated that "caution, rather than favor" defines the approach taken by the UKNSC. In 2024, he remarked, "Individuals often seek simple solutions… which might lead them to perceive us as overly critical. However, I believe time will prove us correct."
Another team member, Bethany Shinkins, a medical statistician and lecturer at Warwick University, stated that the committee must make sure that the "benefits of screening greatly exceed the risks," as they typically test individuals who "feel well" and do not wish to "unnecessarily interfere with people's daily lives."
However, beyond the committee, numerous specialists hold a markedly contrasting perspective on prostate cancer screening—interventions that pose challenging inquiries regarding the composition of the decision-making group.
Members of the committee submit their applications for positions through the civil service job portal, and their selections are endorsed by the Department of Health and Social Care; however, the role is unpaid and offers no monetary compensation.
The selection process considers "expertise and capacity to offer impartial guidance," with the UKNSC site noting that committee members typically consist of people from public life, academic fields, and practicing medical professionals who possess knowledge in one or more pertinent areas.
Public health officials across the region recognize the advantages of large-scale testing. The EU has advanced broader screening initiatives, guided by the European Association of Urology, described as an organization composed of true specialists in urology.
As Mr. Booth notes: "Each year, over 12,000 men die from prostate cancer—more than many of our Western counterparts—since only about half of all cases are detected early enough for treatment."
He stated: "We do not require additional studies. What we need is the immediate application of optimal medical practices — and we need them right away. Men are losing their lives while the UKNSC turns a blind eye."
In its view, the British Association of Urological Surgeons stated that the committee's ultimate suggestions would be "disheartening for numerous men dealing with prostate cancer, along with their families and communities still facing an excessive share of this illness."
It acknowledged that "targeted screening for high-risk groups is a sensible and research-supported method," yet noted that the ultimate suggestion concerns a "limited number of men with elevated risk" where there would be "considerable difficulties in locating them."
David James from the organization Prostate Cancer Research criticized the committee for being "rigid and focused on past practices," arguing that most of the data supporting the rejection of screening among high-risk individuals originated from a time prior to advanced MRI technology, enhanced biopsy methods, active monitoring strategies, and more recent risk-assessment tests—developments that have significantly transformed the detection and treatment of prostate cancer.
"The UKNSC needs to update and revamp its methods, as not doing so could lead to failure in protecting those it was established to safeguard," he stated.
Martin Davies, head of the Prostate Project charity, concurred, stating that the committee's worries regarding excessive diagnosis, unnecessary treatment, and potential damage stemmed from "dated data."
Those days where a positive PSA test inevitably resulted in immediate aggressive treatments are gone," he said. "They aren’t quickly sent elsewhere for an intense biopsy anymore. That’s simply not how things work in reality today.
Professor Frank Chinegwundoh, a specialist in urology working at Barts Health in London, stated that men should have the opportunity to make their own choice about whether they want to undergo screening and 'whether the minor risk of possible damage is less than the advantages.'
His remarks also pointed out another significant omission within the committee, as he expressed being "deeply disappointed... especially concerning Black men who face twice the likelihood of developing prostate cancer."
Alongside prominent urologist Professor Stephen Langley, he stated that the committee's "serious" error of categorizing Black men and individuals with a familial history of the condition alongside the low-risk group was "not based on sound evidence," but rather "medical neglect."
Remarkably, none of the committee members involved in this crucial decision regarding Black men are themselves Black.
Academy Award-winning filmmaker Sir Steve McQueen, whose father passed away due to prostate cancer, criticized the committee as "unforgivable" for failing to include Black men in the screening process. He stated it was difficult to comprehend the absence of diversity within the group and proposed that their decision might have differed if there had been someone present with firsthand knowledge of how this illness impacts Black households.
The panel maintains that broad prostate cancer testing is not permanently excluded, and its stance could evolve with additional research or advancements.
However, considering its extremely cautious history and official statements, activists are reasonably worried that this might take an extended period of time.
The United Kingdom National Screening Committee initially dismissed lung cancer screening in 2007.
By 2014, Professor John Field, an oncology specialist from Liverpool University, was advocating for the swift implementation of screening programs across the UK. He cautioned that each year’s postponement could result in the unnecessary loss of tens of thousands of lives. His argument was supported by U.S. statistics indicating that screening reduced mortality rates by one-fifth.
It was expected that Professor Mackie stated that lung cancer screening would only be advised "when the advantages significantly exceed the risks."
The UK National Screening Committee only suggested a focused lung cancer screening program in 2022, nearly ten years after it was authorized in the United States.
Activists against prostate cancer - along with most men above 50 and their loved ones - will be urgently wishing the committee accelerates its reconsideration this instance.
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