Nirmala Bhoo Pathy, Professor at the University of Malaya and Adjunct Professor at Kasturba Medical College, Manipal, shared a post on LinkedIn:
“The ‘Foreign Gaze’ in Prostate Cancer Screening.
The recently updated Cochrane review revises earlier conclusions -> PSA-based screening likely reduces prostate cancer-specific mortality, may reduce overall mortality, and increases prostate cancer diagnoses. Evidence on harms nonetheless remains limited.
Before Global South health systems join the ‘to screen or not to screen’ debate, there are harder prior questions worth sitting with.
Wonder why?
Current ‘global’ evidence comes largely from populations and health systems in Europe and North America. Applying it elsewhere risks evidence transfer, not evidence-based medicine.
Yes, we certainly need to debate, but the debate worth having is not pro-screening or anti-screening. It is about research equity, health system readiness, and the right of populations to be represented in the evidence that governs their care.
The questions:
- Do we know our own numbers? Cancer registries with reliable incidence, mortality, and stage-at-diagnosis data – disaggregated by ethnicity – are the minimum foundation for any screening policy conversation.
- Do we know our own populations? PSA thresholds, risk profiles, and optimal screening ages derived from European trials may not apply to African, Asian or mixed-ancestry men. We don’t yet know what applies to us.
- Can our systems handle what screening finds? A positive PSA without accessible biopsy, pathology, and affordable treatment is not a screening programme. It is a diagnostic dead end.
- Who bears the harms? Overdiagnosis and over treatment are real concerns…. but in settings where late-stage presentation is the norm, underdiagnosis may be the more urgent problem. The harm-benefit equation is not the same everywhere.
- Who is generating our evidence? If the answer is nobody, that is the policy problem to solve first.
The ultimate policy deficit is tragically, the passive consumption of external data to govern local bodies.”
Other articles featuring Nirmala Bhoo Pathy on OncoDaily.