Applying the Wilson-Jungner criteria for screening, the strongest argument against population-based PSA screening for prostate cancer is that:
- A PSA cannot be measured reliably in peripheral laboratories
- B Natural history is uncertain and many screen-detected cancers would never become clinically significant, exposing men to unnecessary treatment ✓
- C Prostate cancer has no latent, asymptomatic phase
- D Men refuse to accept a blood-based screening test
Correct answer: B. Natural history is uncertain and many screen-detected cancers would never become clinically significant, exposing men to unnecessary treatment
Explanation
Wilson and Jungner require that the natural history of the condition be adequately understood and that early treatment confer benefit over later treatment. Prostate cancer frequently follows an indolent course, so PSA screening leads to overdiagnosis and overtreatment (impotence, incontinence) of tumours that would never have caused symptoms, without a clear mortality benefit. The test itself is cheap and widely available, and acceptance is not the limiting issue.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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