When Jeremy Clarkson went public about surviving prostate cancer, he offered some blunt advice: if your doctor won't test you, lie to get the test. The clip spread quickly — and it raised a question that reaches far beyond prostate cancer, into how we think about cancer screening in general.
It is easy to assume that more testing is always better, and that finding a problem before symptoms appear must give the best chance of a cure. Yet major bodies such as the American College of Radiology explicitly recommend against whole-body MRI screening for people without symptoms [1]. Understanding why means putting the real numbers on the table — and it turns out the honest answer is more complicated than "get every test you can."
This article is general educational information about the current evidence, not personal medical advice. Decisions about screening should always be made with a qualified healthcare professional who knows your individual circumstances.
Table of Contents
- Why a Doctor Might Hesitate About Screening
- Does the PSA Test Actually Save Lives?
- What Saying "Yes" Really Costs
- An Individual Decision, Not a Blanket Rule
- The Screening Programs to Learn From
- Where Cancer Screening Is Heading
- The Bottom Line
- References
Why a Doctor Might Hesitate About Screening
The reason a doctor may hesitate about cancer screening isn't about cost, and it isn't about being unkind. It's that a test is never just a test. The real concern is the chain of events that a positive result can set off. But this needs nuance, and a couple of examples make it clearer.
Consider the US Preventive Services Task Force. In 2018 it issued guidance on prostate cancer screening, concluding that for men aged between 55 and 69, the decision to undergo periodic PSA-based screening should be an individual one [2]. In other words, not a blanket rule for everyone.
So why shouldn't everyone simply get tested?
Does the PSA Test Actually Save Lives?
That is exactly what a large study published in 2024 set out to answer, with a 15-year follow-up period. One group was screened with the PSA blood test, and the other was not. The screened group died from prostate cancer at a rate of 0.69%, compared with 0.78% in the unscreened group over that 15-year window [3].
So screening does work — it lowers the death rate. If that were the whole story, the case would be closed and everyone would be advised to get a PSA test. But it isn't the whole story, because it says nothing about what saying "yes" to that test actually costs.
What Saying "Yes" Really Costs
This is the part that rarely gets mentioned, and it starts with a striking fact. Most men who have prostate cancer never die from it. They die with it — often never knowing it was there. A 2015 autopsy study examined men who had died and looked at how many actually had prostate cancer. The finding: from the age of 79 and above, 59% of the men had prostate cancer that had never harmed them [4]. Had those men undergone a procedure on their prostate, they would have gained no benefit — only the potential for harm.
Here is the critical point. If you go looking hard enough, you will find cancer in a large fraction of the population. The best estimate is that around 40% of the cancers screening finds would never have hurt anyone. But once a cancer is found, it starts a chain reaction that is hard to step away from — beginning with biopsies, which in the prostate example means needles into the gland.
One trial should be on every man's radar. Men with localised prostate cancer were split three ways: surgery, radiotherapy, or careful monitoring. Over 15 years of follow-up, they had the same roughly 2.7% chance of dying from prostate cancer whichever path they chose, with no significant difference between the groups [5].
The survival was the same — but the quality of life was not, because of what treatment can do. In a 2016 study, six months after surgery the share of men with erections firm enough for intercourse had fallen to just 12%, and 46% were using absorbent pads for incontinence [6].
This is precisely the point. It is not a clean yes and it is not a clean no. It is a genuine, difficult decision, and it depends on how a person weighs a small chance of living a little longer against a real chance of treatment harm.
An Individual Decision, Not a Blanket Rule
This is why patient-centred care matters. The era of doctors simply telling patients what to do — the era of paternalism — is giving way to shared decision-making. It is exactly why the prostate cancer guidelines are written the way they are: the decision to screen should be an individual one, made by the person whose health is on the line.
There is a strong case, then, that a patient who feels a doctor is standing in the way of a screening decision has every right to seek help, to talk it through with family, and to seek a second opinion. That becomes even more relevant now, as cancer screening appears to be on the cusp of changing permanently.
The Screening Programs to Learn From
Some cancer screening programs are proven to save lives — bowel cancer screening, mammograms for breast cancer, cervical cancer smears, and lung cancer screening in select populations. The harder question is what to do about the screens where the answer is not clear-cut, like the prostate example. Three concrete cases are worth learning from.
Take thyroid cancer. In the early 2000s, South Korea introduced a thyroid cancer screening program using ultrasound. Large numbers of thyroid cancers were found, and operations followed. But during the follow-up, while diagnoses rose 15-fold, death rates from thyroid cancer stayed flat [7]. People were undergoing operations and interventions with no survival benefit.
Ovarian cancer tells a similar story. A large UK trial combined blood tests and ultrasound in one group and compared it against usual care — and after a median of more than 16 years of follow-up, there was no significant difference in death rates [11]. Screening on its own does not automatically translate into better health outcomes. The lesson is to learn from these examples rather than repeat them.
Where Cancer Screening Is Heading
One possibility is that cancer screening moves towards a time-based series. Instead of rushing in with surgeries and biopsies, the approach would be to step back and rescan regularly with ultrasound and MRI — particularly as scan costs keep falling with improving technology.
But even this strategy has a problem. In 2026, a meta-analysis of over 9,000 asymptomatic people found that whole-body MRI detected cancer in 1.57%, or about one or two in 100 — yet there are still no long-term outcomes showing whether it saves lives [8]. A 1.57% detection rate is not bad. The problem is not the finding rate; it is that no one has shown these scans help people live longer, and the cascade behind every finding is the same one described above. Extra scans risk automatically triggering that cascade of biopsies and surgeries whenever something is found.
Because of this lack of data, a reasonable position is that no doctor should be actively recommending full-body MRIs, given the absence of mortality evidence. But equally, the information should not be withheld, and a doctor should not act as a barrier to a fully informed adult who wants to proceed. A conflict of interest complicates this further: some doctors reportedly hold affiliate arrangements with full-body MRI clinics, earning a financial kickback for referrals. That is not acceptable and should never happen, because it introduces exactly the kind of bias that undermines trust.
One statement captures the honesty this topic demands. Radiologists have proposed an informed-consent statement for anyone in the general population considering a whole-body MRI [9]. It reads:
No medical guideline recommends that you undergo this test. There is a three in 10 chance that we find something that creates uncertainty for you, which could result in anxiety, sleeplessness, financial strain, life disruption, more imaging, invasive procedures, or possibly surgery. Although cancer will be identified in one or two out of 100 people, finding cancer with this test is unlikely to help you because most types will be low risk or already advanced. There are no studies showing that undergoing this test will improve the quality or the length of your life. Based on what we know, if you undergo this test, you are more likely to be harmed than helped, due to complications from efforts to diagnose and treat what we find and the low likelihood we find something that can improve the quality or length of your life. On average, any apparent benefit is likely illusory, even for many cancers. This test does not replace effective but often underused screening tests, such as mammograms or colonoscopies. The cost of this test is borne by you out of pocket, and future care and costs will be your responsibility.
People have the right to make their own informed choices about their health. If you are considering buying this test, our advice is buyer beware. You might lose more than just your money.
Cancer blood tests, such as the Galleri test, add another dimension. These look at specific methylation markers, with the hope that a single test could screen for and diagnose multiple cancers at once. The test was recently trialled by the NHS in England — but in 2026, the result came through, and the trial failed to meet its primary endpoint [10]. That does not mean no one should ever take such a test; it means the current data does not yet support it, and the decision remains an individual one.
Then there is the frontier. One company is attempting to make a whole-body scan that costs almost nothing and takes about a minute: the AI imaging company Midjourney. Its system is essentially a full-body ultrasound, and Midjourney claims this "Ultrasonic CT" can aim for whole-body imaging that is in many ways superior to even MRI machines, with a scan taking as little as 60 seconds — no radiation, no powerful magnetic fields, just sound and water. That, however, is the company's own pitch. In reality it is an early prototype, it is not approved, and radiologists have already pushed back, because sound waves cannot see through bone and air the way an MRI can. "Better than MRI" remains a big claim that has yet to be proven. But the broader direction is unmistakable: scanning is getting cheaper and faster.
The Bottom Line
In practical terms, the strongest starting point is the screening that already has proven mortality benefit for the right group: bowel cancer screening, mammograms, cervical smears, and lung cancer screening in higher-risk people. These are the tests where the evidence shows the benefit outweighs the harm. For the contested screens — PSA testing, whole-body MRI, and multi-cancer blood tests — the right move is not to reflexively opt in or out, but to weigh the real numbers on both sides against personal values, ideally in conversation with a trusted clinician who has no financial stake in the answer.
So where does that leave Jeremy Clarkson and his advice to lie? The honest answer is neither "screen everything" nor "trust the doctor's no." It is that a doctor's job is to hand a patient the real numbers — the good and the frightening — and then support whatever choice that person makes. The final decision belongs to the individual.
That principle also points to a possible future for screening: not a single snapshot in time, but a time-series, where even an alarming finding is followed by watchful waiting to see how it changes on the next scan, rather than an immediate rush to biopsy and surgery. The evidence to prove that approach does not yet exist — but it is the direction that holds the most promise.
References
2. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
3. https://doi.org/10.1001/jama.2024.4011
4. https://doi.org/10.1002/ijc.29538
5. https://doi.org/10.1056/NEJMoa2214122
6. https://doi.org/10.1056/NEJMoa1606221
7. https://doi.org/10.1056/NEJMp1409841
8. https://doi.org/10.1007/s00330-025-11976-5
9. https://doi.org/10.1001/jama.2026.5888
