Equality impact assessment: introduction of a targeted prostate cancer screening programme

Question 1

Introduction of a targeted prostate cancer screening programme

Accepted Answer

In response to a UK National Screening Committee (UK NSC) recommendation, ministers in England have agreed to implement a nationally managed approach to biennial (once every 2 years) PSA testing in men aged 45 to 61 who have pathogenic germline BRCA2 variants with a family history of breast, ovarian, pancreatic or prostate cancer. For the rest of this document, this approach to testing will be referred to as a ‘targeted prostate cancer screening programme’ and the people eligible for this programme will be referred to as ‘men with a BRCA2 variant and a relevant family history’.

BRCA2 is a gene that repairs DNA damage and normally helps to protect against cancer. Some people are born with a variant in this gene and this increases their likelihood of developing certain cancers, including breast, ovarian, prostate and pancreatic cancer.

There is evidence that prostate cancer is both more common and more aggressive in men with a BRCA2 variant and a relevant family history. The UK NSC-commissioned 2025 Cost-effectiveness of prostate cancer screening for men of average and high risk (PDF, 5.9 MB) model indicated that repeat screening in men in this group is likely to do more good than harm.

Background information about screening

Screening is the process of identifying people who are asymptomatic (have no symptoms) but who have an increased risk of developing a disease or condition.

NHS screening programmes are an efficient and proven method for early detection and transfer into treatment services while minimising false positive and false negative results as much as possible.

Early detection for some conditions can deliver clear health benefits by identifying people at greater risk of developing a condition or in the early stages of a disease and supporting preventative action or treatment.

However, no screening test is perfect and there will always be some incorrect results. These ‘false negative’ or ‘false positive’ results can be harmful, as someone may either be falsely reassured or be unnecessarily worried. They might also have invasive or harmful further tests or be given treatments, possibly with side effects, which they do not need.

It can also identify people whose condition would never have become problematic, potentially causing harm through unnecessary anxiety or exposure to treatments from which they are unlikely to benefit.

Striking the right balance is therefore central to good policy. The question considered by UK NSC and subsequently by policy makers is not whether in theory screening would be beneficial - if we had an ideal test and treatment with minimal side effects - but whether it should be recommended for an individual condition using current screening tests and treatment methods.

Each person offered screening should be supported in understanding the possible benefits and risks of screening and in deciding for themselves whether to accept or decline. This is referred to as making a ‘personal informed choice’. In addition, where a condition is detected, people should be supported to make informed decisions about their care.

Background information about the UK National Screening Committee

UK NSC is the independent scientific committee that advises the government and the NHS on all aspects of screening. The committee has an evidence review process which it carries out against evidence review criteria covering the condition, screening test, pathway and interventions. UK NSC only recommends screening if published peer-reviewed evidence demonstrates that the benefits would outweigh the harms.

As health is a devolved matter, the recommendations are considered by ministers in the 4 UK countries, and they determine whether to implement any recommendation and the approach to be taken.

Following the expansion of its remit in 2022, UK NSC considers both targeted and population screening topics. A population screening programme is offered to a group of people identified from the whole population and defined demographically, such as by age or sex. A targeted screening programme is offered to groups of people identified as being at above-average risk of a specific condition.

Compared with the general population, a target population may be at higher risk because of lifestyle factors, genetic variants or having another health condition. For example, people who smoke are at a higher risk of developing lung cancer regardless of their age and sex.

Background information about prostate cancer

Prostate cancer is the most common cancer in men and the second-most-common cause of cancer deaths in men^{[footnote 1]}, with lung cancer the most common cause. Each year in England, approximately 58,000 men are diagnosed with prostate cancer^{[footnote 2]} and around 10,000 lose their lives to the disease^{[footnote 3]}. However, survival is good, with 85% of men surviving for at least 5 years after diagnosis in England^{[footnote 4]}.

Several factors are known to increase the risk of developing prostate cancer. Age is a significant contributor, with the likelihood of diagnosis rising as men grow older^{[footnote 5]}^{[footnote 1]}. BRCA variants, a family history of prostate cancer and Black ethnicity are also associated with a heightened risk^{[footnote 6]}. For instance, the lifetime risk of being diagnosed with prostate cancer is 1 in 4 for Black men, compared with 1 in 8 for White men^{[footnote 7]}.

Prostate cancer can develop in different ways: some types grow slowly and may never cause harm, while others are more aggressive^{[footnote 8]}. Unlike many cancers, most prostate cancer is slow growing and will not cause harm in a man’s lifetime with more men dying with the disease than from it. Data taken from a study of men at autopsy (who had not died from prostate cancer) showed that, at 60 years of age, 1 in 4 men had prostate cancer and by 80 years old this had risen to over a third of the men. A study found that the number of men with prostate cancer at the time of their death may be as much as 30 times higher than the number of men who died from prostate cancer^{[footnote 9]}.

Prostate cancer mortality is heavily weighted towards men over 70 years old with the peak of deaths occurring in men in their 80s. About three-quarters of prostate cancer deaths occur in men aged 75 and above^{[footnote 1]}. The prostate cancer mortality rate per 100,000 men^{[footnote 10]} is:

164 in men aged 75 to 79
310 in men aged 80 to 84
590 in men aged 85 to 90
just under 1,100 in men aged over 90

Prostate cancer is relatively uncommon in younger men, with fewer than 500 cases annually among those aged 45 to 49 and a mortality rate at age 50 of 1.2 per 100,000^{[footnote 10]}.

Over the past decade, the incidence of prostate cancer has increased, a trend that may be attributed to an ageing population and the growing use of prostate-specific antigen (PSA) blood tests^{[footnote 11]}.

The PSA blood test is typically the first step in diagnosing prostate cancer. This test measures the level of PSA in the blood, which can be elevated in men with prostate cancer, but also in men with inflammation or infection of the prostate. As such, the interpretation of PSA results is complex.

While high PSA levels may indicate the presence of prostate cancer, it is important to note that:

around 75% of men with a raised PSA do not actually have cancer
around 15% of men with a normal PSA may have prostate cancer^{[footnote 12]}

This means that the test is far from definitive and carries significant risks of both overdiagnosis and overtreatment, as well as false reassurance and delayed diagnosis for those in the latter group.

The pathway from PSA testing to diagnosis of, and treatment for, prostate cancer has been developed over recent years but remains challenging. National Institute for Health and Care Excellence (NICE) guidance Prostate cancer diagnosis and management (NG131) sets out that, rather than sending every man with a high PSA level straight for a biopsy, current best practice is to undertake a multiparametric MRI (mpMRI) scan first. This scan helps to identify which men need a biopsy and guides where biopsy samples should be taken. Using MRI in this way is helping to reduce unnecessary biopsies and improve the detection of cancers. Nevertheless, when biopsies are required, they can lead to side effects such as pain, infection and bleeding.

Where treatment is considered necessary and the person consents to this, the side effects can be significant. Treatments for prostate cancer, such as radical prostatectomy, radiotherapy and hormone treatment, can result in lasting complications, including urinary and faecal incontinence, erectile dysfunction, mood changes, osteoporosis, diabetes and heart disease.

For example, for men undergoing prostate surgery, after 6 months nearly three-quarters (71%) will find it difficult to control their bladder, with almost 1 in 5 (19%) experiencing moderate to severe urinary incontinence^{[footnote 13]}. Around 3% will have moderate to severe impacts on their bowel habits and two-thirds (66%) will experience moderate or severe erectile dysfunction. For those receiving radiotherapy, nearly 2 in 5 (38%) will struggle with bladder control, 6% will have moderate to severe urinary incontinence, 5% will have moderate to severe impacts on their bowel habits and nearly half (48%) will experience moderate or severe erectile dysfunction.

Recent research findings suggest that minimally invasive focal therapies can lead to fewer - and milder - side effects and better outcomes for patients^{[footnote 14]}. While the risks of urinary difficulties and erectile dysfunction remain, the chance of these side effects is generally considered significantly reduced compared with undergoing prostate surgery. As focal therapies are still under research and are therefore not yet a standard part of the prostate cancer treatment pathway, these were not considered by UK NSC as part of its 2025 review.

These figures highlight the delicate balance between the potential benefits and harms of prostate cancer screening. We are reasonably good at detecting whether there are cancer cells, but much less good at identifying the men in whom the cancer will go on to cause metastasis (the spread of cancer to other parts of the body) and death. In the absence of a test that can successfully differentiate between a faster-growing, more aggressive cancer and the slower-growing, more common form of prostate cancer, early detection and treatment can often lead to treatments that will do more harm than the cancer would have caused.

Therefore, while early detection can save lives, screening asymptomatic men at a population level also carries risk of harm, which must be weighed carefully. Evidence from population screening studies suggests that, for every 1,000 men screened, 28 would be diagnosed with prostate cancer^{[footnote 15]}.

However, the majority of these men (around 80%) would not benefit in terms of preventing prostate cancer deaths or metastasis. This is an expert-derived summary statistic based on data from the:

Many men would receive treatment they do not need, and the harms of screening have been assessed to quickly outweigh any potential benefits. It is estimated that, for every 1,000 men offered screening, 2 lives may be extended, up to 20 are likely to have been over-diagnosed and 12 of those to have undergone unnecessary treatment^{[footnote 15]}.

In 2025, UK NSC undertook an in-depth review of the evidence on prostate cancer screening, examining a range of screening strategies, including targeted approaches. This looked at the cost benefit and health benefits of different scenarios. UK NSC held a 3-month public consultation on a draft recommendation between November 2025 and February 2026. The consultation received more than 900 submissions, which were read and considered. Some further work on the underpinning model was undertaken following the consultation. At the UK NSC meeting on 26 March 2026, the committee made a positive recommendation.

Question 2

Intended aims of the programme

Accepted Answer

The aim of introducing a targeted prostate cancer screening programme in England would be to detect prostate cancer at a stage when treatment is more likely to be successful, reducing the risk of death or disease progression.

Prostate cancer is complex. Unlike most cancers, the majority of cases are slow-growing and will not cause harm in a man’s lifetime. Diagnosing these cancers would be overdiagnosis and could lead to unnecessary treatment that does more harm than good - including incontinence and erectile dysfunction (impotence).

UK NSC has assessed that a targeted screening programme for men with a BRCA2 variant and a relevant family history is justified on the basis that prostate cancer occurs more often, at a younger age and more aggressively for men in this group than for other men.

This means that, for this group, the benefits of early detection and treatment would outweigh the harms associated with overdiagnosis and treatment side effects.

UK NSC has therefore recommended in favour of offering targeted prostate cancer screening for men with a BRCA2 variant and a relevant family history every 2 years, from age 45 to 61. This age range was chosen as it had one of the lowest rates of overdiagnosis, according to the modelling commissioned by UK NSC.

UK NSC’s draft recommendation on which it consulted included a recommendation that men with variants of the BRCA1 gene also be included, as well as men with BRCA 2 variants who do not have a relevant family history. However, after further modelling, it concluded that having a BRCA1 gene variant, or the presence of a pathogenic BRCA2 variant in the absence of a relevant family history of cancer, confers a lower risk of clinically significant prostate cancer.

The 2025 prostate cancer screening cost-effectiveness model commissioned by UK NSC also examined the following screening strategies:

whole population screening for prostate cancer
targeted prostate cancer screening for Black men
targeted screening for men with relevant family history

The evidence indicates that screening the entire population for prostate cancer may result in only a minimal reduction in deaths from the disease. This approach carries a significant risk of overdiagnosis, meaning that the potential harms - including unnecessary treatment and associated side effects - outweigh the potential benefits.

When considering targeted screening for Black men, who have been identified to be at increased risk of prostate cancer, the available evidence is both limited and uncertain, with severe data gaps. If prostate cancer is more aggressive in Black men, screening using current methods may be more beneficial in Black men than the general population. If, on the other hand, prostate cancer cells are more common, but not more aggressive, in Black men, screening them but not the general population would lead to more asymptomatic Black men being treated, with a consequently higher number having side effects due to treatment if cancer cells are detected during screening, but potentially without significantly improved survival benefit.

On balance, the committee therefore could not recommend screening Black men, but did note that further research and more robust data are required. This is to ensure that benefits would outweigh the harms before a positive recommendation can be made for this group.

Finally, targeted screening for men with a relevant family history of breast, ovarian, pancreatic or prostate cancer but without a pathogenic BRCA2 variant - another group identified as being at increased risk - appears to offer a similar balance of benefits and harms as whole population screening, indicating that the risks of overdiagnosis and unnecessary treatment remain a concern in this group as well. It has been identified that there is a need to improve clarity on how to define ‘family history’ which may support further work to improve the evidence base and make recommendations in the future.

UK NSC has recommended against screening for the whole population, as well as against screening for groups other than those with variants of the BRCA2 gene with a relevant family history. It has concluded that further evidence is needed to assess the benefits and risks of screening for men of Black ethnicity and for men with a relevant family history but without a pathogenic BRCA2 variant.

Effect on general practice

The introduction of targeted prostate cancer screening would be expected to have several impacts on general practice, including:

increased presentations to general practice from people seeking a referral to the NHS Genomic Medicine Service family history assessment, risk assessment and BRCA testing
increased numbers of people purchasing direct-to-consumer (DTC) BRCA tests and requesting follow up tests and/or screening
an increase in people seeking advice and guidance on PSA testing, especially people out of scope of the recommendation

Bespoke questions and answers have been developed to support the announcement of the targeted prostate cancer screening programme and will be circulated to general practice. These incorporate a number of clinical scenarios that GPs may face in light of the parameters of the announced programme. NICE quality standard on Ovarian cancer (QS18) and UK Cancer Genetics Group (UKCGG) one page gene-specific management guidelines also provide useful resources to support these discussions.

The NHS is already experiencing an increase in demand from people requesting BRCA tests. The National Genomic Test Directory provides the nationally agreed NHS eligibility criteria for BRCA testing. GPs need support, education and training to ensure they are referring people that meet this eligibility criteria. The Department of Health and Social Care (DHSC) has asked Cancer Research UK and UKCGG to work with experts to develop a comprehensive framework to support general practice in responding confidently and consistently to enquiries from patients who are concerned about a family history risk of prostate cancer.

A further challenge relates to the use of DTC BRCA testing. People could present results from these tests to GPs and request referral into a screening programme, despite the risk that DTC tests may be inaccurate^{[footnote 16]}. The British Society for Genetic Medicine and the Royal College of General Practitioners have published a position statement on DTC testing. This makes a number of recommendations, including that:

healthcare professions should not take at face value, or attempt to interpret, reports from non-accredited laboratories or third-party interpretation services
patients presenting with DTC genomic results to healthcare professionals should be offered the same NHS care as those who have not had DTC genomic testing
DTC genomic testing results should not affect access to treatments that are not commissioned for that indication within the NHS

Alternative PSA sampling methods - such as finger prick tests and self-administered devices that can produce serum equivalent samples - are being explored within NHS England initially within the active surveillance space. These alternative methods could reduce pressure on primary care and help increase participation once fully validated.

In addition to BRCA2 carriers, the NHS MutS Homolog 2 (MSH2) germline pathogenic variant carriers: management guidelines for healthcare professionals (PDF, 230MB) supports consideration of offering PSA testing to carriers of the gene MSH2 from age 40. This group was outside the scope of UK NSC review, so men with a MSH2 gene variant should continue to follow clinical advice given to them at the point of their diagnosis.

To reduce the risk of confusion and misinformation, clear guidance will be required for GPs and men on the use of PSA testing on asymptomatic men who do not qualify for the targeted prostate cancer screening programme or wider CGG guidelines. In light of the UK NSC recommendation, current guidance is being updated to reflect the latest evidence on the balance of harms and benefits, while continuing to leave the provision of a PSA test for men without symptoms to a GP’s clinical judgement.

General practice serves populations with wide variation in deprivation, health literacy, digital access and trust in health services. Without clear boundaries around GP responsibilities, there is a risk that a targeted prostate cancer screening programme could exacerbate existing inequalities.

There is a risk of increased complaints or medico-legal concerns for GPs where screening or referral requests are declined, reinforcing the importance of nationally endorsed guidance and consistent messaging.

Effect on service users

There is concern that announcing a prostate cancer screening programme for men with a BRCA2 variant and a relevant family history could inadvertently encourage people to seek out DTC genetic tests, rather than relying on NHS or NHS-commissioned, United Kingdom Accreditation Service (UKAS)-accredited laboratory testing. Such DTC may fail to detect certain variants or, conversely, may incorrectly indicate their presence, leading to confusion, inappropriate reassurance or anxiety and potential harm^{[footnote 16]}.

It is important to recognise that the risk associated with BRCA2 variants is significantly influenced by family history and other environmental or genetic factors. The presence of a variant alone does not determine a person’s likelihood of developing cancer. There is a risk that people who receive a positive result from a genetic test could mistakenly believe they are certain to develop cancer, underscoring the need for clear communication and education around genetic risk.

As screening would only be offered to men with a BRCA2 variant and a relevant family history, this policy could be perceived as unfairly restrictive by people who have been adopted and so do not have information on family history or by people who may otherwise lack the family history information that informs risk assessment.

For other genomic test indications where a family history is part of the eligibility criteria, the National Genomic Test Directory states that “genetic testing may occasionally be appropriate outside these criteria following discussion at a specialist MDT (multidisciplinary team) with a cancer geneticist present”. Therefore, if an individual does not know their family history (for example, due to being adopted or donor conceived), they should talk to their GP about approaching NHS clinical genetics services for advice on the appropriateness of referrals or requests for genetic or genomic testing.

This policy could also be perceived as unfairly restrictive by groups at higher risk of experiencing prostate cancer - such as Black men and men with a family history - because no screening programme is currently being offered to them despite their acknowledged increased risk, due to a lack of evidence on the aggressiveness of the cancers that they are likely to suffer and on whether the benefits of screening would outweigh the harms. This is why the government is taking a range of actions to improve the position on prostate cancer including committing to:

provide additional funding to the jointly funded National Institute for Health and Care Research (NIHR) and Prostate Cancer UK TRANSFORM screening trial to ensure all eligible Black men are invited to take part in the second stage
work with clinical experts to improve the guidance on family history
invest further capital funds in focal therapies to further develop the evidence for an emerging and innovative treatment, and support the expansion in the TRANSFORM trial
maintain the UK NSC-commissioned SCHARR model, ensuring that it can be updated as new evidence becomes available

People with lower health literacy, limited English proficiency or language barriers may find it more difficult to understand complex information about genetic risk and screening eligibility, increasing the risk of misunderstanding, anxiety or inappropriate reassurance unless information is provided in clear, accessible and culturally appropriate formats.

Effect on laboratories

The introduction of a targeted prostate cancer screening programme would be expected to lead to a modest increase in PSA tests and potentially BRCA tests being processed in laboratories.

To ensure a consistent quality of PSA test processing, the NHS would therefore need to assess the availability of analysers capable of interpreting venous (needle-drawn) blood tests and determine whether processing should be centralised in a small number of laboratories or delivered through a more dispersed model. There is a dependence on industry partners for the availability of PSA test reagents and associated consumables, which are vulnerable to variability in quality.

In addition, evidence on the interpretation of PSA results in specific cohorts, such as transgender women receiving oestrogen, would need to be reviewed to determine whether any modification to the referral criteria would be required.

The impact on histopathology services could be reduced if ultrasound-guided biopsy were to be used, as this would enable the biopsy to be targeted to the area of suspicion, which would result in fewer cores (tissue samples).

Effect on genomics medicine services

The introduction of a targeted prostate cancer screening programme and the associated increased awareness of who is eligible for screening would be expected to place additional strain on genomics services, particularly through an increase in referrals to the Clinical Genetics Service. This service is already under considerable pressure, with patients in some regions experiencing year-long waits for access to appointments with clinical geneticists and genomic counsellors. A Clinical Genomics Service transformation programme is under way to update the current service specification and standardise processes and guidance documents to drive improvements in service delivery.

UK NSC does not currently recommend widescale genetic testing outside the current parameters set by the National Genomic Test Directory to identify men with a BRCA2 variant, as the evidence suggests that the presence of a pathogenic BRCA2 variant in the absence of a relevant family history of cancer confers a lower risk of clinically significant prostate cancer. However, its recommendation states that the best methods to ensure cascade screening for germline BRCA2 status in order to proactively identify and invite men for repeat PSA testing should be evaluated. Evaluation should include, for example, acceptability to the population and professionals, accessibility and the resource impact associated with the strategy. It is noted that any changes to the eligibility criteria for genetic testing for prostate cancer would also necessitate a review of other panels and/or indications for other disease processes that include BRCA2.

The capacity within NHS genomic laboratories and the financial impact of increased genomic testing also need to be considered. The introduction of a screening programme would be likely to increase the number of people who come forward for BRCA testing in line with the current eligibility criteria as outlined in the National Genomic Test Directory. Should it be required, the impact of any change to the eligibility criteria for germline testing in the future would need to consider the capacity and financial impact alongside the benefit.

Effect on diagnostic services

The implementation of a targeted prostate cancer screening programme for men with a BRCA2 variant and a relevant family history would be likely to result in a small increase in demand for contrast-enhanced mpMRI scans and other forms of diagnostic imaging for people with above-threshold PSA levels. However, given that the number of men who will be eligible for screening is so small, the impact on capacity is expected be minimal.

The mpMRI results would inform the need for a biopsy. In some parts of the country, trained nurses or other clinicians can carry out these biopsies, but only if there are enough staff and capacity in place. If this is not available, biopsies may instead need to be done in theatre or by radiologists or urologists. Samples taken during biopsy would require pathology staff and laboratory capacity for timely review. However, as set out above, the impact on capacity is expected to be minimal due to the low number of men who will be participating in the screening programme.

Effect on cancer treatment services

The introduction of targeted prostate cancer screening would be expected to slightly increase demand for urgent suspected cancer capacity and oncology services. Patients would require treatment and care planning. This would need capacity in order to be delivered within cancer waiting times standards, particularly if there is any centralisation of aspects of the pathway to ensure consistency and maintain competence, and to avoid negatively impacting on other treatment pathways and patients.

As per usual practice, all patients identified as having cancer should have access to a clinical nurse specialist or other support worker. Evidence-based information about the advantages and disadvantages of different management options are routinely used in the delivery of this pathway and would need to be maintained for patients and clinicians as the evidence base continues to evolve. Digital and other infrastructure required to support active surveillance would be important. This may be a role for the NHS Online digital platform, which is already planning to include prostate as one of its clinical areas.

Many people identified through screening could require long-term monitoring, including regular blood taking and PSA testing, or could undergo treatments that result in lasting side effects. This would likely lead to a rise in the number of patients needing ongoing consultant support, as well as an increased demand for clinical specialists, support workers and remote monitoring systems.

Urology teams would also be affected, with staff capacity coming under further pressure as they respond to the needs of a growing patient population. Demand for NHS online ‘raised PSA but no prostate cancer’ pathways could increase.

Effect on family members

Any expansion of BRCA testing prompted by a new screening programme could have broader implications for family members beyond heightened awareness of health risks. In some cases, genetic testing can uncover unexpected genetic relationships within families, such as revealing that a person’s biological parent is not who they previously believed. Such findings have the potential to bring about significant changes in family dynamics and personal identity. Guidance for healthcare professionals on managing incidental or unexpected findings is available from the NHS England National Genomics Education Programme Knowledge Hub.

Question 3

Evidence

Accepted Answer

Evidence was considered from the sources described below.

The 2025 SCHARR modelling report Cost-effectiveness of prostate cancer screening for men of average and high risk (PDF, 5.9MB) was informed by published peer-reviewed evidence, national databases, input from experts and patient representatives and workshops attended by a wide range of stakeholders.

The model has been validated against data from 2 major long-term, randomised controlled trials into the effectiveness and harms of using PSA testing to screen for prostate cancer: the Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP) and the European Randomised Study of Screening for Prostate Cancer (ERSPC).

The model assumes the PSA test is the initial test for all screening strategies. If the PSA test result is positive, the person is referred for mpMRI. If the mpMRI result is positive, the person is then referred for a biopsy. A positive biopsy result leads to treatment and surveillance. This aligns with the current NICE guideline Prostate cancer: diagnosis and management (NG131). The model assessed each screening strategy for a one-off screening test. If that looked likely to be effective, the researchers also modelled regular repeat screening test scenarios.

National Prostate Cancer Audit

The National Prostate Cancer Audit (NPCA) is a national clinical audit commissioned by the Healthcare Quality Improvement Partnership (HQIP) in response to the need for better information about the quality of services and care provided to patients with prostate cancer in England and Wales.

The NPCA includes information on the protected characteristics of ethnicity and age, as well as socioeconomic status.

UK NSC public consultation exercise

UK NSC held a public consultation on its draft prostate cancer screening recommendation from 28 November 2025 until 23 February 2026.

UK NSC received almost 900 responses from members of the public and approximately 80 responses from stakeholders (academics, experts, specialist organisations and charities). Further details can be found in the ‘Engagement and involvement’ section of this publication.

Question 4

Analysis of impacts

Accepted Answer

The following section assesses the impact of the introduction of a targeted prostate cancer screening programme towards addressing the following 3 aims of the public sector equality duty:

eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Equality Act 2010
advance equality of opportunity between people who share a protected characteristic and those who do not
foster good relations between people who share a protected characteristic and those who do not

As screening would be offered to men with a BRCA2 variant and a relevant family history in England, equalities analysis has primarily concentrated on the impact of the programme on men with protected characteristics listed in the Equality Act 2010.

While this analysis has been completed for each protected characteristic, it is recognised that there is significant interaction between different factors, which often compound health risks and needs. This includes characteristics protected under the Equality Act 2010, alongside other factors such as deprivation, education and income.

Systematic evidence-based screening should be offered to everyone in a target group, regardless of disability, ethnicity, socioeconomic status, education or other characteristics. It is an inherently fair concept that should reduce health disparities. However, barriers can result in some people being unable to access screening or complete the screening pathway. This can result in people with the greatest need being less likely to benefit from screening, thus increasing health inequalities.

To mitigate against inequalities in screening, the prevention, identification and reduction of health inequalities should be embedded throughout all aspects of the underpinning research into, and design of, end-to-end population screening pathways. It should also be embedded throughout the commissioning, provision, quality assurance and evaluation of screening programmes. This aspect would be captured through an equalities and health inequalities impact assessment (EHIA) that NHS England and the relevant integrated care boards (ICBs) would undertake as part of their duties.

Disability

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of disability would be expected to be neutral.

Evidence shows that people with a learning disability or who are autistic are less likely to access screening^{[footnote 17]}. Guidance for health professionals to support people with a learning disability to access screening is already available on GOV.UK. This will need to be updated to refer to prostate cancer screening for men with a BRCA2 variant and a relevant family history, so that eligible men with a learning disability or who are autistic could be effectively supported to engage with the screening programme. As is standard across all screening programmes where this need is known, communication resources for people with disabilities - particularly people with a learning disability - will need to be produced nationally to inform them about the new programme and how they can access it in a way they can understand and take action. These resources will need to be shared with all relevant charities for dissemination and raising awareness nationally about the eligibility requirements.

Men with physical disabilities who have a BRCA2 variant and a relevant family history and would like to take up the offer of targeted prostate cancer screening could be restricted about where they could be screened and where they could attend any follow-up appointments if facilities are difficult for them to access. This negative experience could deter people from attending their first or subsequent screening appointments^{[footnote 18]}.

Legally, providers of NHS screening services are required to make reasonable adjustments to ensure their services are accessible to people with disabilities. For example, providers must ensure their premises are suitable for the delivery of services and are sufficient to meet the needs of their patients, including those with disabilities. If a person needs specialist equipment, providers must ensure they have access to its use in a safe environment. Current guidance on access to screening programmes explains what providers can do to make reasonable adjustments for people so they are supported to access screening programmes, and this guidance could be used to support the establishment of a national targeted prostate cancer screening programme. To ensure that NHS screening services have the information they need to make these reasonable adjustments, primary care services would need to make sure that the digital Reasonable Adjustment Flag is completed correctly for all people who require reasonable adjustments to access screening.

People with severe mental illnesses are 30% more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests (such as breast, cervical and bowel cancer screening) by people with mental illness^{[footnote 19]}. As such, there may be concerns that men with a BRCA2 variant and a relevant family history who have a severe mental illness may not take up the offer of targeted prostate cancer screening. Further work would need to be carried out at a local level for mitigations to be identified and put in place. Again, primary care services would need to ensure that the reasonable adjustment digital flag is completed correctly for people with severe mental illnesses so that NHS screening services would be aware of any reasonable adjustments that may be needed. As is standard across all screening programmes where this need is known, communication resources about the targeted prostate cancer screening programme will also need to be shared with mental health charities and patient advocates.

Sex

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of sex would be expected to be positive.

The Supreme Court has clarified that the term ‘sex’ in the Equality Act 2010 refers to biological sex^{[footnote 20]}.

As prostate cancer is a male-specific disease, the targeted prostate cancer screening programme would only be directly relevant to men, trans women and non-binary people with a prostate. Trans men do not have a prostate and would therefore not be eligible for prostate cancer screening.

There are examples of indirect discrimination impacting men. For example, Men’s and boy’s barriers to health system access: a literature review (PDF, 2.47MB) shows that accessing health services during standard opening hours is a barrier for people working in certain industries, such as heavy goods vehicle (HGV) drivers, fishing and construction, which have a higher proportion of male workers. Mitigations would need to be put in place, such as offering at-home testing (where appropriate) and flexible appointment times, to ensure that men in these professions would not be prevented from taking up the offer of targeted prostate cancer screening.

A report on Masculine norms and men’s health (PDF, 0.97MB) shows there are harmful societal norms and stereotypes associated with men that can lead to behaviours that are harmful to health, such as encouraging higher alcohol intake or lowering engagement with health services. For instance, statistics show that men are less likely to access bowel cancer screening than women. In the 2023 to 2024 screening year, 70.3% of women took part in the bowel cancer screening programme compared with 64.9% of men. Men are less likely to take up their bowel cancer screening offer, even though men are at greater risk of getting bowel cancer than women. Therefore, there are concerns that some men who would be eligible for targeted prostate screening may not take up the screening offer.

The Men’s Health Strategy for England, published in November 2025, sets out the government’s vision to improve the health of all men and boys in England. It includes tangible actions to improve access to healthcare, provide the right support to enable men to make healthier choices, develop healthy living and working conditions, foster strong social, community and family networks and address societal norms. It also considers how to prevent and tackle the biggest health problems affecting men of all ages, which includes prostate cancer.

Sexual orientation

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of sexual orientation would be expected to be neutral.

Lesbian, gay and bisexual people are more likely to have had negative experiences of using healthcare systems^{[footnote 21]} and this can lead to a reticence to engage with screening programmes.

Prostate Cancer UK information for gay and bisexual men cites research that shows that gay and bisexual men can find changes to their sex life as a result of treatment for prostate cancer particularly difficult to come to terms with. It is therefore possible that this is something that might dissuade some men in the LGBT+ community with a BRCA2 variant and a relevant family history from taking up the screening offer.

A more in-depth review of the inequalities facing gay and bisexual men will be taken as part of the government’s upcoming review to tackle health inequalities experienced by LGBT+ people.

Race

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of race would be expected to be positive for some ethnicities and neutral for others. This is because certain ethnic groups have a higher prevalence of BRCA variants - for instance, people of Ashkenazi Jewish descent.

Men with a BRCA2 variant, particularly at younger ages, have an increased risk of prostate cancer, with studies suggesting risks around 5 to 7 times higher than average. It is this increased risk, alongside evidence that prostate cancers are more aggressive in men with a BRCA2 variant and a relevant family history than in other men, which supports the conclusion that the benefits of offering screening to men in this group would outweigh the harms. While it is known that health inequalities exist for people from specific ethnic minority groups, and that these need to be mitigated against, further evidence is required to assess the impact of implementation of a targeted prostate cancer screening programme on different ethnic groups.

There are known barriers to accessing healthcare for people from specific ethnic minority groups, and there is evidence of racial disparities in the detection of cancer through screening pathways. Studies show that Black people are 38% less likely to be diagnosed with cancer through screening than White people^{[footnote 22]}. This has been linked to the lower uptake of screening among different ethnic groups. A study of bowel cancer screening provision between October 2006 and January 2009 showed that the most ethnically diverse areas had a lower screening uptake than other areas^{[footnote 23]}. According to a study looking at inequality in uptake of bowel cancer screening, there is an association between low uptake and Black or mixed ethnicity compared with White ethnicity.

Between 2013 and 2017, incidence rates for prostate cancer in England were lower in the Asian ethnic group and in people of mixed or multiple ethnicity, but 2.1 times higher in the Black ethnic group compared with the White ethnic group^{[footnote 24]}. Black men in the UK have an age-standardized incidence rate of 166 per 100,000 versus 56.4 for White men, and a 30% higher rate of mortality^{[footnote 25]}. When diagnosed, Black men are more likely to have metastatic or high-risk disease^{[footnote 26]}. However, previous clinical trials have not included enough Black men to provide statistically significant findings in this group^{[footnote 27]}. It is essential that more information is collected on this group in order to ensure that the right decisions are made on prostate cancer screening for Black men. This is why the government has provided NIHR funding to the TRANSFORM trial and is working with Prostate Cancer UK to go further by expanding access to the trial to all Black men in stage 2 subject to successful stage 1 findings. Stage 1 of the trial is looking at different screening strategies as well as making sure the trial runs smoothly and is also determining the best way to engage men in the community to take part in the study. It will ensure that likelihood of harms is not greater than the assumptions used in the current UK NSC model in the whole population and in Black men specifically. The best approaches to cancer detection, harms and costs out of 4 different prostate health checks will be taken forward to the larger stage 2.

This lack of evidence from clinical trials is one of the reasons why evidence on the prevalence of BRCA2 variants in Black men in England is currently limited. Another reason is that ethnicity is not always consistently recorded on medical records. It is therefore not possible to say at this time how many Black men will be eligible for the targeted prostate cancer screening programme.

It is also unclear how the risk faced by Black men compares with the specific risk faced by men with a BRCA2 variant. A direct comparison between these groups is challenging, as BRCA2 is a high‑penetrance monogenic condition, whereas ‘Black men’ describes a socially defined and genetically heterogeneous group whose risk is influenced by both ancestry and social determinants of health. Black men are twice as likely as White men to be diagnosed with prostate cancer^{[footnote 24]}. However, men with a BRCA2 variant, particularly at younger ages, have an increased risk of prostate cancer, with studies suggesting risks around 5 to 7 times higher than average. Current evidence also suggests that their cancers are more aggressive than those in other men^{[footnote 28]}, whereas there is currently little evidence on whether prostate cancers in Black men are more aggressive than those in other men.

Black men living in more deprived communities face 2 significant challenges. They have a higher risk compared with men who are not of African or African-Caribbean descent of developing prostate cancer and living in a deprived area. This means that they can also face barriers to participating in screening programmes, which can further increase health inequalities. However, it is not clear that the same challenges necessarily apply for Black men who live in less deprived communities. A 2024 study on West African genetic ancestry, neighbourhood deprivation, and prostate cancer found lower odds of prostate cancer diagnosis among people with West African ancestry living in less deprived communities, suggesting that it may not be Black ethnicity alone that confers risk but also environmental factors. It is hoped that data from the TRANSFORM prostate cancer screening trial, which is being expanded to include an offer to all Black men in stage 2 subject to successful stage 1 findings, will help to answer these questions.

Founder events occur when a population descends from a small number of ancestors, leading to higher frequencies of certain inherited gene variants within that group. This is why certain ethnic groups have a higher prevalence of BRCA variants. For instance, about 1 in 40 people of Ashkenazi Jewish descent and roughly 1 in 140 people of Sephardic Jewish heritage carry a BRCA variant, whereas the rate in the UK general population is approximately 1 in 250^{[footnote 29]}. The introduction of the targeted prostate cancer screening programme would therefore be expected to directly benefit people within these ethnic groups.

Men from Gypsy, Roma, and Traveller communities experience some of the poorest health outcomes of any ethnic group in the UK. For example, in the 2021 Census, 36.6% of males aged 60 to 64 who identified as Gypsy or Irish Traveller reported bad or very bad health compared with 9.5% of all males in this age group. Gypsy, Roma and Traveller communities have low attendance rates for routine healthcare and screening, as well as low levels of health awareness^{[footnote 30]}. While GP practices are not contractually obliged to ask for proof of address, some will only register patients without a fixed address as temporary patients, which can result in people not receiving invitations to preventive care interventions such as cancer screening and immunisations^{[footnote 31]}. Further work would need to be carried out at a local level for mitigations to be identified and put in place so that men from Gypsy, Roma and Traveller communities who have a BRCA2 variant and a relevant family history would not be excluded from the targeted prostate cancer screening programme.

People who have emigrated to the UK from abroad may not have registered with a GP and therefore may be unaware of services they are entitled to access. This could create a barrier to their uptake of screening services. Even if a person has registered with a GP practice, they may not be aware that they are eligible for screening. Guidance on the health entitlements for asylum seekers and refugees is available on GOV.UK.

People who do not speak English as their first language are also less able to access health services due to language barriers. People who do not speak English:

report greater barriers accessing primary care than those who do
have a poorer patient experience
are more likely to be in poor health^{[footnote 32]}

Language barriers in a targeted prostate cancer screening programme could impact people’s ability to make an informed choice about taking up the screening offer. To help with this in the current NHS screening programmes, information leaflets and videos in 10 other languages are available. This would be picked up through the EHIAs that NHS England and the relevant ICBs would need to complete when planning implementation of the targeted prostate screening programme.

Age

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of age would be expected to be neutral.

Having reviewed the SCHARR 2025 prostate cancer screening cost-effectiveness model (PDF, 5.91MB), UK NSC recommended that the targeted prostate cancer screening programme should be for men aged 45 to 61 who meet the eligibility criteria. This age range was chosen as it had one of the lowest rates of overdiagnosis, according to the model.

The Cancer Registration Statistics for England show that the peak age group for prostate cancer diagnoses in 2023 was in people aged 75 to 79. There may therefore be concern that the upper age threshold of 61 is unfair to older men because of a lack of public awareness of the evidence that shows that screening in the older age group could cause more harm than good. This would need to be carefully communicated in screening programme material.

It is important to note that many men live with prostate cancer without it ever causing harm. Evidence suggests that around 25 in 100 men in their 60s and around 35 in 100 men in their 80s have prostate cancer when they die but do not die from it and may never experience symptoms^{[footnote 9]}.

Gender reassignment

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of gender reassignment would be expected to be neutral.

It is known that transgender people have greater difficulties accessing healthcare, either because of a misunderstanding of their transition or because negative experiences impact how they view all healthcare provision^{[footnote 33]}. Due to this, many transgender people decline screening services when offered^{[footnote 34]}.

It is possible, therefore, that some trans women and non-binary people with a prostate might not feel comfortable participating in a targeted prostate cancer screening programme, particularly given its positioning as a men’s health issue. Specific guidance to hospitals would be required to consider scheduling of their appointments and putting measures in place to uphold dignity.

Delivering an inclusive screening programme for trans women and non‑binary people with a prostate would require careful consideration of primary care IT systems and sex and gender coding.

The NHS Cervical Screening Programme allows people who are not registered as female on their GP record to ‘opt in’ to routine cervical screening. A similar option for the targeted prostate screening programme could help to ensure that people with this protected characteristic who have a BRCA2 variant and a relevant family history would not be excluded from screening.

A more in-depth review of the inequalities facing transgender people will be taken as part of the government’s upcoming review to tackle health inequalities experienced by LGBT+ people.

Religion or belief

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of religion or belief would be expected to be neutral.

There is no data to suggest that any group of people would be directly impacted positively or negatively (in relation to targeted prostate cancer screening) specifically because of their religious beliefs. As noted in the ‘Race’ section above, while BRCA variants are more common among people of Ashkenazi and Sephardic Jewish ancestry, this increased risk is attributable to ethnicity rather than religious belief.

However, for other national screening programmes, there is evidence that certain religious groups are less likely to take up screening offers due to their beliefs. For example, 40% of Muslim women decline bowel cancer screening^{[footnote 35]}, and analysis of NHS data for England showed that areas with the largest Muslim populations had, on average, a 12% lower uptake of cervical screening in the year leading up to July 2022 compared with areas with the smallest Muslim populations^{[footnote 36]}. Based on this experience from other screening programmes, there may be concerns that eligible men within certain religious groups may not take up the offer of targeted prostate cancer screening. Further work would need to be carried out at a local level for mitigations to be identified and put in place.

Pregnancy and maternity

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of pregnancy and maternity would be expected to be neutral.

Men with infant caring responsibilities could potentially find it difficult to attend prostate screening appointments due to childcare issues. This is one of many reasons why there would need to be flexibility and choice around appointment times and locations, as there are with other screening programmes, such as locating screening vans in convenient locations and providing appointments at weekends to fit in with life and work commitments.

Marriage and civil partnership

The impact of the introduction of a targeted prostate cancer screening programme on the protected characteristic of marriage and civil partnership would be expected to be neutral.

While there is no data to suggest that people who are married or in a civil partnership would be any more or less impacted or benefited by targeted prostate cancer screening in comparison with the wider eligible population, there is evidence to suggest that married men tend to have better health outcomes than unmarried men^{[footnote 37]}.

Research into the survival rates of men with prostate cancer shows that married men with prostate cancer survived for longer than separated and widowed patients and patients who had never married.

Other identified groups

This section covers other groups of people (without protected characteristics) that may be impacted by targeted prostate cancer screening.

Men living in deprived areas

Evidence from other screening programmes indicates that people from deprived communities are less likely to participate in screening programmes^{[footnote 38]}.

Local identification of areas of missed opportunity and areas where improvements can be made to engage with people living in more deprived areas would need to be made. Mitigations currently in place in other screening programmes include:

text message reminders
locating screening vans in easily accessible areas
weekend appointments to fit around work and life commitments

These mitigations could also be integrated into the targeted prostate cancer screening programme. Bespoke solutions relevant to different communities would need to be developed at a local provider level. This is in line with NHS England’s statement on information on health inequalities which provides guidance on how health inequalities information should be used to inform local action.

The abdominal aortic aneurysm (AAA) screening programme introduced an inequalities coverage standard^{[footnote 39]} to reduce health inequalities by ensuring coverage for the programme is improved in the 3 most deprived deciles. This is reducing the number of men suffering from ruptured AAAs who are disproportionately from areas of higher levels of deprivation.

The Cancer in the UK 2025: socioeconomic deprivation report, which looked at all cancers and not just prostate cancer, showed that cancer incidence in general is higher in people living in more deprived areas, largely due to the higher prevalence of cancer risk factors like smoking and obesity. This report also showed that cancer survival is lower in people living in more deprived areas. This is linked to later-stage diagnosis, due partly to lower uptake of screening for early diagnosis, and treatment differences. For all cancers combined, the likelihood of presenting through an emergency presentation route in England is more than 50% higher for people living in the most deprived areas compared with the least, even after controlling for age and sex.

However, the Cancer Registration Statistics for England in 2022 show that higher numbers of prostate cancers are diagnosed in men in the least deprived quintile compared with the most deprived quintile. This may be linked to the increase in men who live in less deprived communities requesting a PSA test from their GP, as a result of high-profile awareness-raising campaigns led by charities such as Prostate Cancer UK.

Men from less deprived areas may be able to pay privately for BRCA tests and therefore bypass NHS waiting lists for genomics testing. This could further entrench health inequalities, as those in more deprived communities are less likely to have the means to access private healthcare and so may have to wait longer to find out if they have a BRCA2 variant and could therefore be eligible for targeted prostate cancer screening.

The Men’s Health Strategy for England recognises the significant impact of deprivation on men’s health outcomes and has a strong focus on addressing these inequalities. It also supports the government’s overarching ambition to halve the gap in healthy life expectancy between the richest and poorest regions, while increasing it for everyone.

For example, on 27 March 2026, we announced a partnership with charities Movember and People’s Health Trust to improve men’s health and tackle health inequalities. The programme will bring voluntary, community and social enterprise organisations into the heart of delivery to:

test new community models
learn what genuinely works for men,
build better ways of reaching those who are underserved and least likely to engage with traditional services

An evaluation will be funded through NIHR to ensure the programme generates robust evidence to inform future policy on men’s health.

The Men’s Health Strategy also commits to exploring the evidence base on health inequalities more broadly, including those linked to deprivation. We will particularly focus on identifying what works - in varied settings and across multiple conditions - for different groups of men.

Homeless men

Although it is not necessary to have a home or proof of address to access medical care, 8% of homeless people are not registered with a GP^{[footnote 40]}. This can result in exclusion from invitations to screening.

People experiencing homelessness are also exposed to increased risk factors for cancer such as substance abuse, risky sexual practices and environmental pollutants^{[footnote 41]}.

Further work would need to be carried out at a local level for mitigations to be identified and put in place so that homeless men with a BRCA2 variant and a relevant family history would not be excluded from the targeted prostate cancer screening programme.

Men in prison

The uptake for other screening programmes is low for people in prisons, and steps that have been taken to improve this in other screening programmes could also be applied for the targeted prostate cancer screening programme. Current prisoner behaviours can create barriers, including the use of aliases, which can make it difficult to follow up with people upon their release into the community.

Work is ongoing to incorporate targeted questions in the initial assessment clinic to identify men who are established BRCA2 variant carriers and could therefore be eligible for targeted screening. This will be of particular importance if these tests have been undertaken outside of England as these men will not be on the National Inherited Cancer Predisposition Register.

Question 5

Engagement and involvement

Accepted Answer

Two events were held to discuss the evidence relating to the UK NSC draft recommendation on screening for prostate cancer.

UK NSC public consultation exercise

UK NSC held a public consultation exercise on the following proposed recommendation to:

offer a targeted national prostate cancer screening programme to men with confirmed BRCA1 and BRCA2 variants every 2 years, from ages 45 to 61
not recommend population screening
not recommend targeted screening of Black men
not recommend targeted screening of men with family history
collaborate with the TRANSFORM trial team to:
- answer outstanding questions on screening effectiveness for Black men and men with a family history as soon as trial data becomes available
- await results of the study to develop and trial a more accurate test than PSA alone, in order to improve the balance of benefit and harm of screening

The consultation ran from 28 November 2025 until 23 February 2026, and UK NSC received nearly 900 responses from members of the public and approximately 80 responses from stakeholders (academics, experts, specialist organisations and charities). A summary of the main points is embedded in the coversheet provided on the UK NSC prostate cancer recommendation page. A list of the consultation responders and their comments is available at the same link.

In addition to seeking consultation responses, UK NSC engaged with a wide range of stakeholders including NHS England, universities, charities (including Cancer research UK, prostate Cancer Research and Prostate Cancer UK) and professional bodies.

Prostate cancer screening roundtable of experts

On 28 January 2026, the former Secretary of State for Health and Social Care The Rt Hon Wes Streeting MP, and the Chief Medical Officer Professor Chris Whitty, hosted a roundtable that brought together a range of views and examined the evidence and arguments on the UK NSC’s draft recommendation on prostate cancer screening. The aim of the event was to have a scientific and clinical discussion about technical areas of prostate cancer screening using current diagnostic tools and current treatment.

Attendees included academics, consultants, clinical advisers, researchers and charitable organisations (including Cancer Research UK, Prostate Cancer Research and Prostate Cancer UK).

Question 6

Summary of analysis

Accepted Answer

Overall impact

The introduction of targeted prostate cancer screening would be expected to affect primary care, increasing demand for BRCA testing and GP appointments, and support for patients seeking advice. GPs would need clear guidance, training and communications, particularly around eligibility criteria and managing new referral pathways. While some additional pressures might be expected from incidental findings and aftercare for men undergoing treatment, the impact should be minimal given the relatively small number of men who will be eligible for the screening programme.

The programme will also impact wider services, including laboratories, genomics, diagnostics and cancer treatment teams. However, as set out above, any impact should be minimal.

In terms of men with protected characteristics and people in other identified groups, such as men with a BRCA2 variant and a relevant family history living in deprived areas, it is clear that mitigations would be required to ensure that the introduction of a targeted prostate cancer screening programme would not widen existing health inequalities.

For those groups that have an elevated risk of prostate cancer but would not be eligible for the targeted prostate cancer screening programme in its current form due to a lack of evidence (namely Black men and men with a family history of prostate cancer but without a pathogenic BRCA2 variant), there is - understandably - a high level of concern. This is why the government is taking a range of actions to improve the position on prostate cancer, including committing to:

provide additional funding to the jointly-funded NIHR and Prostate Cancer UK TRANSFORM screening trial to ensure all eligible Black men are invited to take part in the second stage
work with clinical experts to improve the guidance on family history
invest further capital funds in focal therapies to further develop the evidence for an emerging and innovative treatment, and support the expansion in the TRANSFORM trial
maintain the UK NSC-commissioned SCHARR model, ensuring that it can be updated as new evidence becomes available

Addressing the impact on equalities

There are risks that certain groups would not be able to access targeted prostate cancer screening due to current known inequality issues. These could be alleviated through a range of methods, including training staff to address concerns, and public awareness campaigns to increase uptake among low uptake groups. However, there remains the risk of certain groups not engaging with the service and therefore the positive impact on inequalities not being as large as it could be.

Current mitigations in screening programmes have been outlined in the evidence above.

Mitigations include:

provision of translated leaflets for those whose first language is not English
accessible screening clinics for people with disabilities
provision of fixed screening appointments
text, NHS App notifications and/or letter reminders for appointments
targeted communications to groups with lower uptake rates of screening

Legally, providers of NHS screening services are required to make reasonable adjustments to ensure their services are accessible to people with disabilities. For example, providers must ensure that their premises are suitable for the delivery of services and are sufficient to meet the needs of their patients, including those with disabilities. If a person needs specialist equipment, providers must ensure they have access to its use in a safe environment. Guidance on access to screening programmes explains what providers can do to make reasonable adjustments for people so they are supported to access screening programmes.

NHS England is improving its screening IT systems. A Reasonable Adjustment Flag is now available for screening call and recall. This automatically indicates that reasonable adjustments (such as accessible information) are required by a person to help them access screening.

The Men’s Health Strategy for England, published in November 2025, sets out the government’s vision to improve the health of all men and boys in England. It includes tangible actions to improve access to healthcare, provide the right support to enable men to make healthier choices, develop healthy living and working conditions, foster strong social, community and family networks and address societal norms. It also considers how to prevent and tackle the biggest health problems affecting men of all ages, which includes prostate cancer.

The Men’s Health Strategy sets out that service provision organisations should:

provide services at times and settings that reflect men’s working and family lives
adapt communication styles to engage and retain men
ensure staff are equipped to identify and address men’s diverse health needs, and recognise the importance of male role models across the profession

NHS England has identified the collection of ethnicity data and mapping it against Index of Multiple Deprivation data as a priority for all cancer screening programmes. If this were also to be implemented for the targeted prostate cancer screening programme, this would enable local regions to understand which sub-groups of their population to focus on to improve engagement with screening.

The government has provided NIHR funding to the TRANSFORM trial and is working with Prostate Cancer UK to go further by expanding access to the trial to all Black men at stage 2, subject to successful stage 1 outcomes. Stage 1 of the trial is looking at different screening strategies as well as making sure the trial runs smoothly and determining the best way to engage men in the community to take part in the study. It will ensure that likelihood of harms is not greater than the assumptions used in the current UK NSC model in the whole population and in Black men specifically. The best approaches to cancer detection, harms and costs out of 4 different prostate health checks will be taken forward to the larger stage 2.

A more in-depth review of the inequalities facing people in the LGBT+ community will be taken as part of the government’s upcoming review to tackle health inequalities experienced by LGBT+ people.

The NHS Cervical Screening Programme allows people who are not registered as female on their GP record to ‘opt in’ to routine screening. A similar option for the targeted prostate screening programme would help to ensure that trans women and non-binary people with a prostate who have a BRCA2 variant and a relevant family history would not be excluded from screening.

Monitoring and evaluation

Under current arrangements, NHS screening programmes are monitored under section 7A of the National Health Service Act 2006, as amended by the Health and Social Care Act 2012. This may change in future when NHS England is merged with DHSC.

Question 7

Conclusion

Accepted Answer

The findings of this equality impact assessment suggest that the introduction of a targeted prostate cancer screening programme for men with BRCA2 variants and a relevant family history could have the potential to deliver significant health benefits to the eligible population. As the programme would target a group at demonstrably higher risk, its success would depend on ensuring that eligible men could understand, access and complete the screening pathway without avoidable barriers.

The assessment highlights that eligible people with disabilities, those with severe mental illness, and people facing structural or logistical barriers would be at risk of being excluded unless robust reasonable adjustments and clear support mechanisms were embedded from the outset. Ensuring accessible facilities, tailored communication and proactive local mitigations are in place would be essential to prevent widening health inequalities.

It is essential that more information is collected on ethnicity and family history to ensure that the right decisions are made on prostate cancer screening for Black men and for men with a family history who do not also have a pathogenic BRCA2 variant. This is why the government has provided NIHR funding to the TRANSFORM trial and is working with Prostate Cancer UK to go further by expanding access to the trial to all Black men at stage 2, subject to successful stage 1 outcomes. The government is also working with clinical experts to improve the guidance on family history.

Socioeconomic deprivation, unstable housing, and imprisonment could also present significant obstacles to equitable screening. Lessons from other national screening programmes demonstrate that tailored, locally driven interventions (such as flexible appointments, mobile units and improved data collection) are critical to reducing health inequalities in screening.

Overall, the assessment indicates that a targeted prostate cancer screening programme would have the potential to reduce mortality for a higher‑risk group, but only if implementation were to be accompanied by strong national guidance, comprehensive communication, and sustained action to identify and remove barriers across diverse communities. Continued monitoring, evaluation and adaptation would be crucial to ensuring that the programme would reduce, rather than compound, existing health inequalities.

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Introduction of a targeted prostate cancer screening programme

Background information about screening

Background information about the UK National Screening Committee

Background information about prostate cancer

Intended aims of the programme

Effect on general practice

Effect on service users

Effect on laboratories

Effect on genomics medicine services

Effect on diagnostic services

Effect on cancer treatment services

Effect on family members

Evidence

Sheffield Centre for Health and Related Research (SCHARR) 2025 modelling study

National Prostate Cancer Audit

UK NSC public consultation exercise

Analysis of impacts

Disability

Sex

Sexual orientation

Race

Age

Gender reassignment

Religion or belief

Pregnancy and maternity

Marriage and civil partnership

Other identified groups

Men living in deprived areas

Homeless men

Men in prison

Engagement and involvement

UK NSC public consultation exercise

Prostate cancer screening roundtable of experts

Summary of analysis

Overall impact

Addressing the impact on equalities

Monitoring and evaluation

Conclusion

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