Pap tests are free: why must the prostate pay?

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      This year, more than 500 British Columbia men are expected to die of prostate cancer, while almost 700 women will perish from breast and cervical cancers.

      The provincial government's Medical Services Plan covers the cost of mammography and Pap smears to detect breast and cervical cancers, respectively. But when men like Laurence Armstrong get a prostate specific antigen (PSA) test to screen for cancer, they have to pay.

      Armstrong says this smacks of sexual discrimination. Nobody would hire Armstrong, a Victoria-based lawyer, for a $30 lawsuit–which he notes is the average cost of a PSA test. So he decided to file a complaint against the government with the B.C. Human Rights Tribunal two years ago. He describes his complaint as a "representative action for all men". A decision has yet to be handed down by the tribunal.

      "I sit here patiently waiting," Armstrong told the Georgia Straight by phone from his office. "It's so annoying that the women get free mammograms and Pap smears. And men, because we're all trained to be stoic and brave and silent”¦so the government just takes advantage of us. We end up having to pay for what women have for free."

      According to Armstrong, there is a 90 percent cure rate if prostate cancer is detected early. He asserted that universally administered PSA tests would prevent the majority of deaths from prostate cancer.

      According to the Canadian Cancer Society, prostate cancer is slow-growing and can be managed successfully. The size of a large walnut, the prostate is located just below the bladder at the base of the penis. Prostate cancers start in the glandular tissue of the prostate.

      Armstrong said he's at a loss why the province doesn't want to pay for PSA tests. So he offered up a joke instead. "We all like breasts; breasts are nice things. They stick out and we all see them and we all enjoy watching them, and prostates are tucked up your bum hole and they're not so nice," he said with a chuckle. "It [the prostate] doesn't have the same sort of sex appeal."

      When asked to comment, the Ministry of Health sent the Straight a statement pointing out that PSA tests are "covered if a doctor determines that the test is medically necessary".

      "In 2005/06, MSP paid for more than 177,000 PSA tests," the statement noted. "MSP coverage decisions are based on the best clinical evidence available, and if new evidence comes to light, our policies are shifted accordingly to ensure patients benefit from the highest standard of care."

      It also said the health ministry "relies on recommendations from medical and scientific experts when making decisions on the funding of any medical test". The ministry's statement also pointed out, "The province continues to closely monitor new research as it emerges."

      In 2006, the B.C. Human Rights Tribunal tossed out the B.C. government's motion to dismiss Armstrong's complaint. "Had Mr. Armstrong been a woman and wanted to have either a Mammogram or PAP cancer screening test done, it would have been paid for by MSP," tribunal member Judy Parrack wrote in her ruling. "The fact that he requires a screening test, which is only provided to men, and which is not paid for by MSP is sufficient, at least at this stage of the process, to conclude that there is an act that, if proven, would be captured by the [Human Rights] Code."

      Armstrong isn't the only B.C. resident upset about paying for the tests. Surrey resident David Purser is turning 59 this year, and it cost him $27 to have a PSA test. He didn't have the disease.

      "It doesn't seem fair," Purser told the Straight. "I don't have anything against females getting the screening tests, but why not the males? It's not about the cost. It's about the principle."

      Canadian Cancer Statistics 2007, a report by several public-health agencies and nonprofit organizations, states that prostate cancer (after lung and colorectal cancers) will be the third leading cause of death among B.C. men who die from cancer this year. It noted that 550 men in this province are expected to die of the disease this year.

      For B.C. women, breast cancer will be the second leading cause of death, after lung cancer. The study estimated that in 2007, 640 women will die of breast cancer here, while 50 others will succumb to cervical cancer.

      The study stated that the incidence rates of prostate cancer across Canada had two peaks: one in 1993, and a smaller one in 2001.

      "This is compatible with two waves of intensified screening activity with the PSA (prostate specific antigen) test for [detecting] early prostate cancer," the document explained. "The first follows the introduction of PSA as a screening test; the second”¦may be explained by the publicity around Allan Rock's, then Canada's Minister of Health, diagnosis with prostate cancer in early 2001 as a result of serial PSA tests."

      The study also noted that prostate cancer mortality "declined significantly" between 1994 and 2003, "probably due to a combination of earlier detection and improved treatment".

      Breast-cancer incidence rose steadily but gradually across Canada between 1978 and 1999, the paper noted. It added that this may have been due to the "gradual uptake of screening, especially mammography, that took place during the 1980s and 1990s".

      "This would result in identification of cases of breast cancer earlier than would have occurred without screening," the study stated. "The breast cancer death rate in 2003 is the lowest it has been since 1950."

      The incidence of cervical cancer and mortality rates due to that cancer in Canada have been declining for many decades, largely due to widespread regular use of Pap screening tests, the study also noted.

      According to the Canadian Cancer Society (, all men over the age of 50 should discuss with their doctor the potential benefits and risks of early detection using PSA and digital rectal examinations. It added that according to the World Health Organization, it isn't clear whether or not PSA screening reduces the number of deaths from the disease.

      Purser's long-time friend Grant Hughes wishes he had been tested much earlier. The 74-year-old Delta resident learned he had prostate cancer in 1992. He quit practising law a year later. Hughes told the Straight that if PSA tests were done on men after the age of 40, a lot of lives would be saved. "It's too late for me," he said. "But if I had been tested at 40 or 45, or even 50 or 55, they might have caught it in time to get rid of it."