Which saves more lives, and is better value for money, a programme distributing the vaccine against cervical cancer, or a national screening programme for prostate cancer?
Everyone is going nuts that the state has delayed the roll-out of the vaccine, but I’m fairly sure, after a brief glance at the death figures, that the prostate cancer service would be better value.
Oh, and on a related topic, does anyone know where I can find an age profile for cervical cancer? I googled, but I didn’t get one.
I’m confused. Your title mentions some sort of prostate cancer vaccine (which AFAIK doesn’t exist…and can’t, since prostate cancer isn’t caused by a virus,) but the OP is about the cervical cancer vaccine.
And what do you mean “the state has delayed roll-out of the vaccine.” Which vaccine and which state? AFAIK, the cervical cancer vaccine is approved for sale in all 50 states, so are you in a country that’s not the US?
And why would the two be mutually exclusive? I’ll assume you are talking about Gardasil here, since there is no prostate cancer vaccine. One cancer affects women, and the other men, so it’s not like only doing one or the other would be very beneficial.
Sorry thats a massive typo, it’s meant to say Cervical cancer vaccine.
I’m Irish, and we are having some severe budgetary problems, so the government has decided to abandon the free provision of the vaccine to under-12s (it was due to start this year). There was also recently a nationwide cervical screening programme being rolled out.
Now everyone is going nuts (despite the fact that no-one gave the Minister in question any credit to begin with :rolleyes:), because they say that she is abandoning the women who die of cervical cancer, BUT, when I looked at the figures, it seemed to me that a focus on prostate cancer would be better.
We have a tax-funded healthcare system, so it is very much a case of one or the other.
Gardasil (HPV vaccine) will definitely help prevent cervical cancer, although there are other controversies about its use as a public health measure.
Prostate cancer screening is a lot more tricky. The two big controversies are how to screen, and how to treat. To show benefit as a public health program you must show that the screening is cost-effective. Therefore how to screen becomes an issue. But you must also show that once you’ve found the cancer, you know how to treat it for a net savings in quality of life and/or mortality. And I don’t think that’s very settled yet. If I have a bit more time I’ll try and post with some relevant article links.
My gut notion is that it would be easier to prove a net public health benefit from “a Gardasil program” than prostate screening, but I am not an expert.
Hope these are helpful.
Right now I’d say the short answer is that HPV vaccine has more evidence for cost-effectiveness if it’s used in young women than does prostate cancer screening. This is not quite the same thing as saying that it’s more cost-effective, or a better “value” for the state.
No, it’s not. The proposed HPV vaccinination programme would have cost €10 million. That’s peanuts in a system that wastes such an incredible amount on middle management and bureaucracy.
The case for prostate screening (which effectively means PSA testing in this context) is not proven. PSA has a relatively low specificity and sensitivity for prostate cancer…in other words there are plenty of conditions, such as prostatitis and benign hypertrophy of the prostate that cause an elevated PSA, and the PSA test is not always elevated in cases of prostate cancer.
Most GP’s will routinely check the PSA any time they do routine bloods in men over 50, and will follow up appropriately with rectal examination, and referral to the urology service if there’s any suspicion of a problem.
On the other hand, Gardasil vaccination actually prevents the development of cancer. It’s really the first time that we can vaccinate against a cancer. The vaccine is available to but on private prescription, but is not even eligible for the Drug Refund Scheme, let alone for medical card patients. It costs €140 per dose wholesale, and you need three doses. I’ll leave it to your imagination to figure out what kind of markup can be made on this.
Pretty much every European country has now a HPV programme in place, and as far as I’m aware, most of the US has a programme in place as well. It’s a sensible public health measure, and it’s shameful that it’s not being implemented.
It’s a very limited population: they were proposing to vaccinate girls in 6th class of primary school, with virtually no catch-up campaign.
The €10,000,000 was quoted in an interview on Newstalk radio yesterday by Dr James O’Reilly, who admittedly has his own axe to grind as the opposition health spokesman.
However, the cost of the campaign is also cited here.
:dubious: There is no such thing as only €10,000,000.
We had all our spending adjusted to boomtime, and we are now in recession. We can’t maintain spending at the level it was, nevermind increase it.
There are several differences between prostate screening and cervical cancer vaccine and screening, some to do with the screening themselves, some to do with the diseases.
Prostate cancer is a disease of old age. 90% of 90 year old men will have some evidence of prostate cancer at autopsy. This prostate cancer, however is not likely to be the cause of deathin the majority. The proportion of men who will live with their prostate cancer rather than die from it is quite large.
If you have positive PSA you need a transrectal ultrasounds scan and biopsy of the prostate. If that is positive you get to decide either on “watchful waiting” or a prostatectomy- a major surgery with impotence and incontinence as relatively common side effects.
The argument against screening ASYMPTOMATIC men for prostate cancer is that you will inevitably operate on men who would never have developed a cancer aggressive enough to kill them, or who would have died of heart disease, lung disease or simple old age well before they died of prostate cancer. The argument is that by screening this population of men you risk causing more harm than good.
Cervical cancer vaccine could cut rates of cervical cancer by 60% in 20 years. The screening programme, while not perfect, is good at picking up early changes that with relatively simple, cheap and relatively risk-free treatment can totally prevent a woman ever developing a cancer that would more than likely be the cause of her death.
You’re not comparing like with like, you’re comparing apples with oranges.
Basically it’s about QALYs- Quality Adjusted Life Years. More people live longer, better quality lives per euro spent on cervical screening than with prostate screening. In an ideal world there would be enough money for everything, when you have to ration you need a sound basis to work out how, the QALY is, at the moment, pretty much the best we have.
You vaccinate 20 girls at 12, they have cervical smears every 3 years from 25- 3 end up requiring LLETZ procedures to remove cancerous cells from the cervix (a procedure lasting 15 minutes that takes a day or two to recover from) and all of them live to 80 free of cervical cancer- you save 1360 QALYS.
You screen 20 men beginning in their their 40s- detect raised PSA levels in 15- the TRUSS is positive in 8- 6 of whom have prostatectomies- a major surgery requiring weeks to recover from. Assuming all the men also live to 80 and none die of prostate cancer (best case scenario) you save 800 QALYs for vastly greater expense and with much riskier interventions.
