It's easy to put off screening for prostate cancer. Health insurers should step in

A paramedic holds a test tube containing a blood sample. Simon Dawson/PA

Imagine for a moment that you are a fifty-something male, had a deceased first-degree relative who was treated for prostate cancer and that you haven’t been screened for the disease in a while. You are a bit sketchy on when exactly you were last tested, but you’re pretty sure it wasn’t that long ago. A little later, you’ll work out it was around five years previously, which is far longer than you thought it was.

Imagine, too, that you know the risks your confection of circumstances compounds to. Healthcare providers generally recommend taking a Prostate-Specific Antigen (PSA) blood test every couple of years when you are more than 50 years old, so that’s one demerit point for leaving it so long. Add another demerit for being older anyway. Prostate cancer awareness information resources typically remark that “all men” are at risk of prostate cancer and the most common risk factor is advancing years.

And then there is your family history. Your father was diagnosed and treated for prostate cancer, but died within five years of treatment, albeit his death was unrelated to his diagnosis. So that’s one merit point for recognising you may be at higher risk due to biological history and two demerits for not getting tested when you fully understand your family history puts you at greater risk than normal.

Now add another demerit for not heeding a recent reminder from your peer group. A friend had treatment for prostate cancer at the end of last year and gently nudged you to get tested the last time you saw them. To which you’d replied that “of course you would” and that you’d had regular tests over the years – and then being a should-know-better fifty-something man you’d promptly parked that thought for several months. And that’s another demerit for wilful inaction when regular checks are a key health prevention technique.

Prostate cancer is high on the list of under-diagnosed cancers and causes of cancer mortality globally, principally due to either lack of awareness of testing or misinformation about screening methods. A recent study in the Clinical Oncology Journal found that a significant percentage of men in the Middle East “are diagnosed with advanced stage disease … and the majority of patients received their prostate cancer diagnosis after presenting with symptoms, rather than through routine PSA testing”.

If you hadn’t worked it out already, that “you” is “me” and, fortunately, there isn’t a sad end to the story. I took a PSA test and my results were fine, but the experience did kick up several points about awareness, detection and prevention.

First there was the issue of getting a test in the first place. Health insurers often cover some or all of the costs for annual screening for prostate cancer for men over 45 years, but don’t remind you to do so. If there is a general aspiration for preventive medicine involving early detection and potentially better medical outcomes, then the most effective way to reach that goal would be for insurers to be proactive by reminding those in higher-risk groups to get tested or, better still, facilitating regular screening. At least one Abu Dhabi health group has made progress in that regard this year, which is a step forwards. Even so, some of us are unlikely to schedule regular tests without prompting, when it is too easy to make a hollow promise to book yourself in soon, like I did.

A reminder from the insurance company or even an accessible mobile screening programme would break through that procrastination and would be a solid step towards a better quality of life.

As it is, my test prompted a suggestion for a colonoscopy, another preventive and diagnostic screening, which is recommended every few years for anyone over 45 years old. Surely, again, this could be part of a managed screening programme in support of early detection of colon cancer or other gastrointestinal diseases. Health insurers are not just managing risk, they are looking after well-being. As it is, I will have to pay for this screening and then claim the money back, making it the sort of procedure that becomes easier for someone to put off until tomorrow or next year what they should be doing today.

I also opted to receive my PSA results through a telemedicine consultation, figuring that it was more time-efficient for both doctor and patient and because I could get an appointment sooner than one in-person. But when the appointment was missed, I got fed into the contact centre mixer, which brings its own language of case escalation and complaint registration. I didn’t want that either, I just wanted my results.

At the end of each call, I was also surveyed, which reminded me that customer experience questions are unreliable snapshots of stress and mood. Telemedicine will play a big part in all our futures, but finding the right way to deliver it and accurately test patient experience will be key to fully unlocking its potential.

If we want the best outcomes, barriers must be lifted and accessibility to treatment, tests and results needs to be made as easy as possible. Until they are, that imbalanced merit-demerit score card simply won’t add up.