Simple test for men over 50 that could save thousands from death
Chris Stubbs played squash, worked out, hardly drank and ate only healthy foods — but there was one niggling health problem that was bothering him.
‘I thought I must have piles because I kept bleeding when I had a bowel movement,’ recalls Chris, 50, a pharmaceutical sales manager who lives in Henley-on-Thames, Oxfordshire, with his wife Liz, a PA.
‘It was embarrassing and I tried to shrug it off, hoping it would go away — but it didn’t. I’d never had piles before.
Calls have been made to lower the national screening age for bowel cancer from 60 to 50
‘I told Liz and she suggested I get it checked out. I didn’t relish the thought of talking about my bowel habits or having a rectal examination — so I left it two weeks.’
The bleeding symptoms continued every day. Later that month — January 2009 — Chris finally went to see a trainee GP.
She gave him a rectal examination but just suggested he go away and come back in a few months. This was despite the fact she admitted bowel cancer was a possibility when Chris asked her what might be wrong.
‘She was fairly noncommittal, but as I was young, and wasn’t experiencing symptoms like pain, tiredness or weight loss, I was reassured by her advice,’ he says.
But five months later, Chris was diagnosed with bowel cancer.
The most common age group to be diagnosed is the over-60s, and all men and women of this age are offered screening under a national programme in England, Wales and Northern Ireland. But Chris is one of more than 2,498 men and 1,902 women in their 50s found to have bowel cancer every year in the UK.
Last month, the head of leading charity Beating Bowel Cancer called for the national screening age for the disease to be lowered from 60 to 50.
Dr John Donohue, a consultant at Lewisham Hospital in London, has welcomed government moves to tackle bowel cancer
The bowel disease is also called colo_rectal cancer and includes large bowel cancer (colon cancer) and cancer of the back passage (rectal cancer or cancer of the rectum).
Symptoms include blood in stools, weight loss and extreme tiredness. It is the second most common cause of cancer death in the UK. More than 38,000 people were diagnosed in 2008 and 16,250 people died from the disease — one every 30 minutes.
Austrian research published last month in the Journal of the American Medical Association found that men in their 50s have a much higher prevalence of polyps (small lumps which can turn cancerous) and cancerous tumours than women of the same age.
For instance, the prevalence of adenomas (non-malignant tumours which grow in the bowel and can turn cancerous) in men aged 50 to 54 was 18.5 per cent, similar to the 17.9 per cent rate found in women of 65 to 69.
The authors suggested it may be important to start screening men even earlier than 50.
‘We want the Government to act now to introduce screening at 50,’ says Beating Bowel Cancer’s chief executive Mark Flannagan.
‘Bowel cancer has a survival rate of over 90 per cent if caught at the earliest stage. Earlier screening could save at least 5,000 lives a year.’
A photo taken during a colonoscopy is seen in this handout photo released by the University of Wisconsin Medical School
But some experts are less convinced. Dr John Donohue, consultant gastroenterologist at Lewisham Hospital, London, and director of South-East London Bowel Cancer Screening Centre, says: ‘One study isn’t enough to change our policy.
‘The Government’s commitment announced last year to provide flexible sigmoidoscopy for all 55-year-olds within three years is going to have a much bigger impact. Research suggests it could reduce deaths from bowel cancer by 30 to 40 per cent.’
In a flexible sigmoidoscopy, a flexible tube and camera is used to examine the left colon where statistically polyps and tumours are most likely to form.
Men and women aged 60 to 69 in England, Wales and Northern Ireland are screened with kits sent in the post containing faecal occult blood tests, which check for blood traces which may not be visible in stools. People take samples and send them off to laboratories.
Polyps and bowel cancers sometimes bleed, before symptoms become apparent, which is why bowel motions are screened.
If the test picks up an abnormal result, patients are offered more further investigations such as sigmoidoscopy or the more invasive colonoscopy, in which a flexible tube attached to a camera is used to examine the entire colon.
Austria uses colonoscopy to screen patients, but UK experts feel this is too invasive and expensive and best reserved for those who have already had an abnormal screening test result.
Dr Steven Hughes, consultant gastroenterologist at Southmead Hospital, Bristol, vice president of the British Gastroenterology Society, adds: ‘If you screen at a later age you will pick up more cases of bowel cancer but the cancers will be more advanced and less easy to treat.
‘If you screen at an earlier age you detect earlier stage cancers and polyps, but you also see a lot of people who don’t have either.
“In an ideal world, with unlimited money, we’d say let’s screen everyone at 50. We are in favour of early diagnosis — but we are also in favour of most effective use of resources.
‘We are already hitting problems this year with the introduction of screening for 70 to 74-year-olds. It’s not difficult to provide the test kits — but there are problems providing follow-up endoscopies. If we extended screening to people in their 50s, we would need more resources to provide highly trained staff.’
The National Bowel Cancer Screening Programme costs the NHS 77.3million a year to screen 60 to 69-year-olds alone.
Chris, at least, is convinced a screening test at 50 may have detected his cancer earlier.
His symptons persisted after he was sent away the first time, and when he made it back to the surgery in the middle of March 2009 he was seen by another more experienced GP. On hearing about the bleeding he immediately referred Chris on to hospital.
‘Because I have private medical insurance I was seen within a week,’ says Chris.
‘My specialist said it was probably a polyp and it might be cancerous and I was booked in for a colonoscopy. On May 19 the colonoscopy showed up a bright red polyp. The surgeon said he’d have to wait for test results, but that it was probably cancerous.’
A week later bowel cancer was diagnosed.
‘I can’t say I broke down in tears as I still felt it could be just cut out,’ says Chris.
‘I had to stay positive and Liz took the same attitude.
‘However, I was wrong. Before I could have surgery I had an aggressive five-days-a-week course of chemotherapy and radiotherapy for five weeks to shrink the tumour so it could be removed safely.
‘The treatment worked and two months later in November 2009 I had surgery to remove the tumour and a section of my bowel.’
‘The surgery involved a temporary colostomy stoma, where an opening is made in the abdomen to collect waste for three months, but my bowel was later rejoined and the colostomy bag removed.
‘I have CT scans every six months — with an early stage cancer like mine the cure rate is 93 per cent. So far all my scans have been clear and so I’m very positive.
‘But I’m very aware that I’m one of the lucky ones.
‘Introducing screening at 50 would undoubtedly save lives. Sometimes I dread to think what would have happened to me if I hadn’t gone back to the doctor for that follow-up appointment.’