7 January 2026

Should the NHS stop screening patients for cancer?

Some are subjected to unnecessary therapies, which can cause significant harm

W hen the UK began breast screening in the late 1980s, no one suspected that we often form cancers that never cause clinical disease. Once we started systematically searching for unsuspected tumours, though, it became apparent that we were picking up many more cancers than would have been expected. The concept of overdiagnosis was born.

Overdiagnosed cancers generally can’t be reliably distinguished from ones that will go on to cause disease or death. Consequently, they get treated with equal aggression with surgery, radiotherapy, chemotherapy or immunotherapy. This has given rise to the tandem concept of overtreatment – patients subjected to gruelling therapies that are entirely unnecessary, and which themselves cause significant harm.

This is a particularly counter-intuitive problem. No one who has an unsuspected cancer detected ever thinks they might have been a victim of overdiagnosis – they conclude they’ve been incredibly lucky and will gratefully endure whatever treatment is offered. Conversely, patients tragically presenting with late-stage clinical cancer may assume that their outlook would have been improved had they been part of a routine screening programme – even though aggressive tumours have frequently spread and become incurable long before they are detectable.

For every breast cancer death prevented by the screening programme, it is thought that another three women are turned needlessly into cancer patients. And because treatment can cause serious side effects like heart failure or secondary cancer, some estimates suggest the entire screening effort is now doing more harm than good – which has led one of the architects of the original programme to call for it to be disbanded.

If overdiagnosis poses difficulties in breast cancer screening, it is far worse when using PSA blood tests to detect prostate tumours. For every death postponed, ten men will be turned pointlessly into cancer patients. This is what underpinned the UK National Screening Committee’s (UK NSC) recent draft recommendations on prostate cancer screening. While they suggest offering regular PSA tests to middle-aged men at highest risk – those with mutations in the BRCA gene, whose families will typically have multiple cases of breast, ovarian and pancreatic as well as prostate cancer – they did not endorse screening in any other scenario. The widespread harms were judged to greatly outweigh any at best objectively slim benefits.

The draft recommendations are now out for consultation, and the Health Secretary, Wes Streeting, will make the final decision in March. He is going to come under intense pressure. The UK NSC’s verdict met with “deep” and “extreme” disappointment from prostate cancer charities, media outlets like the Daily Mail, and public figures who have personal experience of the disease such David Cameron and Chris Hoy. Prostate cancer screening has become a cause célèbre.

Proponents of mass screening believe that doctors are now better able to work out which prostate tumours are being overdiagnosed. They also believe that other higher-risk groups, like black men or those with a strong family history of disease, would benefit from regular testing. The UK NSC noted these arguments but insists that research evidence is needed. Prostate Cancer UK has begun a clinical trial to address these questions.

Streeting would be wise not to move ahead of the UK NSC. It is politically impossible to dismantle an extant programme on the counter-intuitive grounds that it is causing more harm than good. Then there is the unpalatable question entirely absent from the public debate. Are the vast efforts being made to find tumours before they present clinically – which turn many more people into cancer patients than they possibly help – really the best use of constrained resources? We might very well be better off refocusing the NHS on timely treatment for those with actual disease and leaving healthy people alone to be just that.

[Further reading: Why can’t I get contraception as a gay woman?]