As a Consultant Gastroenterologist working at The Physicians’ Clinic and St Mark’s Hospital in Harrow, North-West London and a nationally accredited bowel cancer screening colonoscopist, Dr Chris Fraserhas a special interest in bowel cancer screening. We interviewed him to find out why awareness of this disease is still far too low and why Bowel Cancer Awareness month is so important.
Why don’t people know enough about bowel cancer?
“Embarrassment costs lives. The taboo surrounding bowel habits means that awareness is nowhere near as high as it should be. Most people fail to realise the bowel cancer is the second biggest cancer killer in the UK, claiming 16,000 lives each year. It is also the third most common cancer after lung and breast cancer in women and lung and prostate cancer in men.”
We’ve seen reports published today that just over half of people eligible for bowel cancer screening actually do the test. What's your view?
“This is a real concern. The FOBT (faecal occult blood test) based NHS bowel cancer screening programme is effective and has been running since 2006. An FOBT is easy, painless and involves sending a small poo sample using a simple test kit designed to detect tiny quantities of blood back in the post to the hospital.
If the test is positive, you are then called for a colonoscopyto check for polyps, which are removed if detected.” “Polyps are small growths in the colon that are usually benign but if they are not removed, there is a risk that they could grow larger and turn into bowel cancer. Since most bowel cancers develop from polyps, having polyps removed during colonoscopy greatly reduces the risk of getting bowel cancer.”
Is FOBT screening the only way to detect bowel cancer?
“No, a new bowel cancer screening initiative called Bowel Scope has been piloted in six centres in England this year. The idea is to offer all people aged 55 the chance to have a flexible sigmoidoscopy. This is not a full colonoscopy; we use it to look inside the left part of the colon only, but that is where the majority of polyps and bowel tumours are.
If anything abnormal shows up, the next step is to do a colonoscopy, provide treatment and then follow up with regular surveillance colonoscopies as necessary.”
Does bowel cancer screening save lives?
“Definitely. Both FOBT based screening (followed by colonoscopy) and the newer Bowel Scope screening programme have been thoroughly tested for their impact on death rates. Research published by The Lancet in 2010 showed that the death rate from bowel cancer was 43% lower in people who had a screening flexible sigmoidoscopy in their late 50s than in people who didn’t.“
What’s the difference between bowel cancer screening and diagnostics?
“Bowel cancer screening is done population-wide on people without any symptoms or known risk factors. Early stage bowel cancer and pre-cancerous polyps often don’t produce symptoms, so screening is the only way to identify who is affected.” “Bowel cancer diagnostics are done in people with symptoms.
What symptoms should people be worried about?
“The danger or red flag signs are a change in bowel habit (e.g. to looser stools rather than constipation) that last more than two or three weeks, any blood noticeable in the stool, unexplained abdominal pain, signs of anaemia(bleeding in the bowel can be significant), unexplained loss of weight and feeling very tired. Obviously, many of these symptoms can occur for other reasons but it’s always best to see your GP and ask for a referral to a gastroenterologist.”
Is bowel cancer becoming more common in younger people?
“There is good evidence that many more cases are being diagnosed at an earlier and therefore more curable stage due to screening but it’s important to maintain a perspective. More than 80% of bowel cancers are diagnosed in people 60 years or more but that doesn't mean if you are younger than this and develop symptoms, that these should be ignored and not investigated further. So it’s important to be aware of these symptoms and ask for medical advice earlier rather than later.”
What increases the chances of developing bowel cancer?
“Apart from age, various genetic conditions can make bowel cancer more likely. You need to tell your doctor if you have a family history of bowel cancer, or if any close relatives who died young from the disease. People who have inflammatory bowel disease– either ulcerative colitis or Crohn’s disease – can be at increased risk of bowel cancer compared to the general population.
If you are known to be at higher risk, you will be offered bowel cancer surveillance. This involves regular colonoscopies to monitor the health of your large bowel.”
Do you offer bowel cancer screening at The Physicians’ Clinic?
“Yes, people can have all forms of screening from FOBT, flexible sigmoidoscopy, colonoscopy to a CT scan of the colon (CT colonography). For most people, I and probably the majority of other gastroenterologists would recommend colonoscopy. Done thoroughly and carefully, this is a one-step, well tolerated investigation that can reveal any abnormalities in the large bowel and really importantly (unlike some other screening tests) remove any pre-malignant polyps found at the same time.
“In the future, I anticipate that the new screening methods that are on the horizon could become available in private practice first. We are still talking maybe five years away but the possibility of performing DNA and molecular sampling on stool samples to detect markers for pre-cancerous polyps and early bowel cancers is getting ever closer.”