Surgeon takes prostate cancer screening to the community

Surgeon Jyoti Shah won’t let men die of embarrassment. Instead of waiting for patients to come to her, she goes out and gets them.

The number of men dying from prostate cancer has overtaken female deaths from breast cancer for the first time in this country, according to statistics uncovered by the charity Prostate Cancer UK1. Up to 40% of cases are diagnosed late, in stages 3 and 4. Miss Jyoti Shah, consultant urological surgeon at Burton Hospitals Foundation Trust, created an award-winning project that goes to football grounds and town halls to offer men the chance to be tested.

What’s the Inspire Health campaign about?

Prostate cancer is the most common cancer in men but awareness is poor. Men are also reluctant to seek medical attention – because of fear or embarrassment, or they say they were too busy to go to the GP.

I was doing talks to raise awareness but it wasn’t enough. I spoke to my colleague Sarah Minns, a Macmillan Urology advanced nurse practitioner, and said let’s set up a community clinic. We didn’t wait for permission, we went under the radar and just made it happen in our spare time.

Burton Albion football club is at the heart of our West Midlands community. I approached the chairman to see if we could do screening at the ground. In March 2016 we ran 10 days of awareness, with coverage in the local paper, profiling treatments such as radiotherapy, surgery, chemotherapy, showing people that you can treat prostate cancer – there’s a life beyond diagnosis. It all led up to the clinic at the Pirelli Stadium, where we saw 113 men and found eight cancers.

How does it work?

Volunteers help us to run the sessions. There are usually 100 men over two days. Sarah takes bloods for prostate specific antigen (PSA) testing, I take a full medical history, then carry out an examination. Derbyshire Blood Bikes collect our samples for the lab. I get home, have a quick shower, then I’ll call back anyone whose examination was abnormal and ask them to come and see me in hospital for further tests including a biopsy, usually within a week. I also call in everyone whose PSA test is abnormal.

I write to every patient, and their GP, explaining the results and my recommendations. Two-thirds of the men diagnosed with cancer were picked up on examination, not PSA testing.

How many men have you seen?

Nearly a thousand. We’ve held screening sessions anywhere from town halls to masonic lodges. The freemasons were all dressed in their regalia and we were led in by procession. Women are usually not allowed in so it’s a great privilege.

How do you cover the costs?

Sarah and I don’t charge for our time or travel and the venues are free. I’ve dropped two of the sessions I work a week, taking a pay cut. I also need time to follow up and analyse results. I make this up to the trust by doing extra sessions. Consumables such as blood bottles, syringes, cotton wool cost about £4.50 a head. I don’t fundraise, but people donate. One of my patients raised £700 from his fishing club, someone else held a raffle and gave £400.

We are booked up every month until July next year.

Sarah and I have shown doctors and nurses can work well together. That’s broken a stereotype.

That’s quite a commitment.

I’ve found something that I truly believe in, and if I do something, I have to do it properly. I’ve had criticism – because there’s no national screening programme I’m seen as doing something that’s not recommended.

But I’ve raised awareness on a massive scale. I gave a talk at the Jalaram (Hindu) Temple in London to 500 people in June. As an Indian woman, going into the Asian community was crossing a barrier – prostate cancer is a taboo subject – but they welcomed me with open arms.

We won the regional stage of the NHS 70 Parliamentary awards and we were shortlisted for the national finals. It’s very humbling, but most of all the Inspire Health campaign means 950 men are reassured and we have saved 47 lives by spotting their prostate cancer. You can’t buy that.

Do you think the NHS should create a national screening programme?

With PSA screening alone, the numbers needed to test to save one life are massive. And I’m not sure how feasible it would be to replicate what we are doing around the country. It’s expensive to have urologists or surgeons and all the kit in the community. But we are building the evidence; we presented a poster on our work at the annual scientific meeting of the British Association of Urological Surgeons (BAUS) in June.

Did you always want to be a surgeon?

I was discouraged from pursuing a career in medicine by my school in west London – no-one from there had ever gone on to study medicine – by my father and by my community. They said why not do a pharmacy degree and open a shop? But I’ve always had self-belief. This is not a job, it’s a vocation, it’s my life. 

1  https://prostatecanceruk.org/about-us/news-and-views/2018/2/we-call-on-uk-to-step-up-as-new-figures-show-prostate-cancer-now-a-bigger-killer-than-breast-cancer (drawing on ONS figures 2015)