Spotting bowel cancer at an early — and curable — stage remains a problem within Britain. In the Netherlands they do much better with nearly a fifth more people surviving at least three years following diagnosis. About 38 per cent of patients diagnosed in the Thames region are picked up with early stage of bowel cancer compared to 55 per cent in the Eindhoven area.
An additional concern in this country is that about a quarter of people with bowel cancer present to hospitals at a late stage as emergencies with a blockage or a perforation of their bowel. Such patients often don’t do well.
A national screening programme is running to try to pick up bowel cancer earlier. It entails smearing a sample of your own faeces on to a special card, which is then sent away to check for any signs of hidden bleeding.
Unfortunately — and probably understandably — the uptake for this test has been disappointing. The most recent figures indicate that only 58 per cent of people participate compared with well over 70 per cent for both breast and cervical cancer screening.
So what can be done to make sure bowel cancers are picked up early enough to be cured? I have four suggestions.
1. Know your risks. As a GP the way I respond to symptoms is linked to my assessment of an individual’s level of risk.
None of us, even if we have been screened, are at zero risk for bowel cancer. Many of us know that getting older affects the chances of getting many conditions, including bowel cancer, but we need to be aware of a range of other risk factors too.
Having close relatives — father, mother, brothers or sisters — diagnosed with bowel cancer increases a person’s odds of developing it themselves. Moreover if your relations have been diagnosed with the condition before the age of 45 this increases your chances considerably.
Having medical conditions yourself such as Crohn’s disease, ulcerative colitis, bowel polyps or diabetes can also heighten your risk.
2. Get Screened. The current NHS bowel cancer screening programme offers screening every two years to all men and women aged 60 to 69 (starting within two years of your 60th birthday). People over 70 can request a screening kit by calling the freephone helpline 0800 707 6060.
Given the slow uptake of this form of screening the NHS has started to look at alternatives. In England flexible sigmoidoscopy screening as a one-off at the age of 55 is being slowly rolled out but coverage remains patchy. It is best to approach your GP to ask about the options in your area.
Many private screening companies in Britain now follow the advice of the United States Preventive Services Task Force, which recommends screening for bowel cancer from aged 50 to 75.
We also need to follow the lead of our colleagues in the United States and to tailor screening more according to a person’s overall level of risk rather than simply by their age.
3. Be aware of early symptoms Any bleeding from the back passage, or on your motions, can be a key symptom for early bowel cancer. If you are over 40 years old — as I say to my patients — don’t just assume it is piles.
Other symptoms that matter include:
• Unexplained weight loss
• Unexplained abdominal (tummy) pain
• Changes in your bowel habits — for example looser motions than six months previously
As a GP with an interest in cancer diagnosis one issue that often concerns me is when a patient with diabetes is told that their abdominal pain, diarrhoea or constipation is linked to their diabetic medicines. Some tablets used to treat diabetes can certainly cause these symptoms but I think it is foolhardy not to consider bowel cancer in light of the increased chances of developing the condition.
4. If you have anaemia make sure you know why. The possibility of bowel cancer should always be considered in individuals over the age of 40 years with any degree of anaemia (and in younger people at heightened risk). In a recent study of 431 patients seen in general practice with iron-deficiency anaemia, 7.4 per cent had bowel cancer. Moreover some individuals had anaemia for more than a year prior to diagnosis, perhaps representing a missed opportunity for earlier diagnosis and improved survival.