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Mobile testing "Man Van" can diagnose prostate cancer in at-risk groups earlier and more affordably than GPs, according to new research. Sending mobile health clinics into areas of high deprivation and ethnic minority communities picked up more clinically significant prostate cancer—86% of cancers, compared with 50% through comparable studies—meaning fewer men are sent for unnecessary treatment. The research, which was presented at London Global Cancer Week at the Houses of Parliament on Friday 15 November, showed that this approach could be up to 25% cheaper than the standard GP route.
Targeting at-risk groups The Man Van project, developed by The Institute of Cancer Research, London, The Royal Marsden NHS Foundation Trust, and RM Partners, NW and SW London Cancer Alliance, aimed to find undiagnosed prostate cancer. Black men have double the risk of developing prostate cancer and an increased risk of having prostate cancer diagnosed late, when it is more difficult to treat. Similarly, men in deprived areas face higher rates of death from cancer than those in more affluent areas.
The nurse-led van was stationed in seven locations across London based on the population of ethnic minorities and the level of deprivation, in sites such as a football club, a community center, outside IKEA, a health center and a town hall. The Man Van worked with local community leaders to encourage men to visit the van and worked closely with local hospitals to ensure people were referred within two weeks. Approach picked up more clinically significant cancers More than 3,000 men visited the Man Van over the course of a year.
The approach meant Black men made up 16% of those seen in the van, and 22% of those diagnosed with the disease were Black. Of the 94 prostate cancers detected via high levels of prostate-specific antigen (PSA) in a blood test , 81 (86%) were clinically significant—meaning treatment was likely to be needed to prevent the disease from progressing. In other screening studies, only 50% of cancers detected were clinically significant—meaning that men may undergo unnecessary MRI scans, invasive biopsies, and treatments.
The researchers conducted a cost analysis and estimate that a PSA test in the Man Van could be 25% cheaper than screening via the GP—with costs reducing from £68.41 via the GP to £51.11 through the van.
Man Van also picked up other health conditions In an earlier pilot study of more than 600 men, Black men made up 30% of the visitors to the Man Van, and 67% of the 15 prostate cancers detected. Of these 15 cancers, 10 (67%) were clinically significant. As well as a PSA test for prostate cancer, men visiting the van had their blood pressure, BMI, and a blood marker of diabetes checked.
Of the 600 visitors, almost 4% had undiagnosed diabetes, and 50 of the men had pre-diabetes. The clinic also detected one case of bladder cancer, and one of esophageal cancer. There are other mobile testing units known as "health trucks," which look specifically for liver or lung cancer.
The researchers suggest that the Man Van model—combining education and awareness-raising with health checks—should be implemented into screening programs to tackle health inequalities and ensure at-risk communities are reached. Tackling health inequalities Dr. Masood Moghul, Clinical Research Fellow at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, said, "This is the first evidence-based assessment of how mobile screening units could tackle health inequalities, reaching groups who have historically been diagnosed with cancer at a later stage when it's more difficult to treat.
"We reached these groups through community stakeholders—charities, churches, employers and a housing association—to raise awareness of the importance of these health checks and how to get involved. "The high number of Black men that we reached, and the proportion of problematic but treatable prostate cancer that we detected—in areas where typically 25% of men present with incurable cancers—shows the success of this targeted outreach model." 'A very powerful model' Professor Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust said, "Diagnosing cancer early is so important because it's much easier to treat, but some cancers don't have any symptoms until they've been growing for a while.
"It's disproportionately people in deprived areas and from ethnic minorities who are having their cancers detected late, when it's more likely to be deadly. To catch these cancers early, we need to be proactively helping people by offering health checks. "As the debate continues for the best prostate cancer screening method—one that won't cause over-treatment, or fail to detect people with deadly cancers—we need to improve health care access for those at a higher risk of disease.
These results show that our Man Van is a very powerful model that should be considered for wider use across the country." Professor Kristian Helin, Chief Executive of The Institute of Cancer Research, London, said, "It is vital to detect cancer as early as possible, before it has spread, to give people the best chance of survival. It's a shocking fact that Black men, and men living in poorer areas, are more likely to die from prostate cancer than others.
With cases set to double by 2040, we must have a program in place to reach at-risk groups, closing the gap and ensuring that cancer is caught early.".
