In early January 2015, NHS England announced the introduction of a new scheme as part of its five year plan. Under that proposal, as part of an early diagnosis programme for cancer, patients will have the option to refer themselves for diagnostic tests without going through a GP. The scheme will be piloted in partnership with Cancer Research UK and Macmillan Cancer Support.
On the face of it this is good news, although the details are not yet clear. The NHS is rightly keen to involve the patient in the care process as an informed and motivated patient might help make delivery of care more efficient. The more “traditional route” is that the first step to a diagnosis would be an appointment with a primary care professional such as a GP to discuss a patient’s concerns followed by testing to rule out or confirm a diagnosis.
There is certainly a good argument that the “self-diagnosis” route has benefits. By allowing a patient to proceed straight to investigation and to avoid the need for a GP consultation, it is conceivable that the process of obtaining a diagnosis and any subsequent treatment needed will not only be much quicker but it will also reduce the pressures placed on surgeries.
However, given that prostate cancer is the most common cancer in men in the UK, with over 40,000 men being diagnosed with the disease every year and 250,000 men currently living with the diagnosis, how will the proposed new scheme affect those who are worried that they might have this form of cancer?
It is likely that the diagnostic tests available for self-referral will be limited to ultrasound, scanning, x-rays and, possibly, flexible sigmoidoscopy. Blood tests may also be included. It is highly likely that some men who are particularly at risk - ie those over 50 and/or with a family history, with or without some symptoms of enlargement of the prostate - might want to make use of this screening. However, it is important that awareness is raised of the risk factors and the options available to the patient to make the system to work and to help patients to make an informed decision.
Tim Wright of Penningtons Manches comments: “The simplest test will be screening of a blood sample for Prostate Specific Antigen (PSA). But this a controversial test because it is so difficult to correlate the result to a diagnosis of a tumour which might benefit from treatment or regular observation.
“There is an ongoing debate about what constitutes a positive PSA level with a recent paper in the British Medical Journal suggesting some baseline levels of PSA in three stages. These stages will determine whether no further screening is necessary; a discussion with a doctor is required; or a further screening and a scan should be undertaken. Any positive result will, of course, be a cause of worry for patient but, in some cases, a positive result may not be an indication of a disease which needs treatment or, indeed, further investigation.
“In those circumstances - and bearing in mind that most positive results will be in the first group - the “pros and cons” of the self-diagnosis route over the more traditional route will need careful consideration as it is important to avoid causing any unnecessary distress to the patient if they receive a positive result.
“The proposal to allow patients access to investigations without a GP referral certainly has merits, particularly as patients are not relying on a GP’s judgement on whether investigation is necessary. The Penningtons Manches team has come across cases where a delayed diagnosis and treatment of prostate cancer has adversely affected a patient’s prognosis. These proposals could help speedier identification of treatable disease. Removing the need for a GP referral will also add the benefit of freeing up resources in the community. On balance, while there are certainly benefits of the self-diagnosis system, awareness must also be raised to make it work.”
For more information about Prostate Cancer Awareness Month visit http://prostatecanceruk.org/