The result, in black and white on the letter, was clear: bowel cancer. It was advanced – stage four – meaning it had already spread.
The chance of a cure, I knew, was small. I felt a wash of sadness, and then something else: intense anger.
In fact, I was furious. This wasn’t ‘my’ bad news, as such. You see, I’m a GP, and the letter concerned a 57-year-old patient – let’s call her Karen. The mother-of-two had first come to see me in January, complaining of blood in the stools and loose bowel movements.
She said it had happened on and off for a few months, but it just hadn’t worried her enough to seek help.
In 2018, following pleas from cancer experts, the Department of Health and Social Care pledged to take steps to lower the bowel cancer screening age from 60 to 50. Yet, we’re still waiting. By 50, an individual has double the risk of developing it than at 40
The cancer was now in Karen’s lungs, liver and ovaries. The odds were she wouldn’t survive for long. But my fury wasn’t for how cruel fate can be. It was because I knew that it could have been avoided had the Government delivered on its promises to screen all over-50s for bowel cancer.
Given its advanced stage, there’s every likelihood the tumours in Karen’s bowel had been developing for many years. A simple test could have picked that up at an early stage, when we could have saved her.
In 2018, following pleas from cancer experts, the Department of Health and Social Care pledged to take steps to lower the screening age from 60 to 50.
Yet, 18 months later, we’re still waiting. Tragically, if Karen had been living a few hundred miles north, in Scotland, where the screening age is 50, it’s likely she’d be cured.
Instead, she missed out on a chance for her cancer to be picked up early, and she’s facing a likely death sentence. She isn’t my only patient with such a story and I’m sure there are hundreds, if not more, across the country.
By the age of 50, an individual has double the risk of developing bowel cancer than at 40. It is estimated that nearly 5,000 fiftysomething Britons who get bowel cancer every year could be saved thanks to early detection from screening. So why is the Government dragging its feet?
Patients are dying – when their cancer is preventable
Over the past decade, the Government has made great strides in reducing the toll of bowel cancer in the over-60s. And this is largely down to screening. From 2006, from the age of 60 and then every two years until the age of 74, every Briton receives a DIY test kit in the post.
The original test that was sent out was called a faecal occult blood test (FOB).
It looks for traces of blood in stools that might not be noticed just by looking. A positive result would warrant further investigation – usually a colonoscopy, a procedure that involves a camera on a long, thin flexible tube being threaded through the bowels.
In its first ten years, the programme detected 25,000 cases of bowel cancer that may otherwise have been missed.
Every year, bowel cancer (cell, above) is responsible for 1,200 deaths in 50-to-59-year-olds – many easily avoidable. Public health campaigns often focus on telling patients not to be ‘embarrassed’ to report bleeding, a sign of the disease. But the truth is, without screening, it’s the Health Service that is failing the public
Many these would have been at an early stage, when the disease has 90 per cent cure rate. Screening prevented a further 81,000 by spotting pre-cancerous growths. But the FOB test wasn’t perfect.
As many as half of those who received the test didn’t do it. And it involves collecting samples of stool on three separate occasions, which for some people can take weeks.
In addition, not all bowel growths bleed – meaning the test could throw up false negatives. And if you had red meat the night before, the blood you ate could trigger a false positive test result.
In 2016, a new more accurate test became available. Known as the faecal immunochemical test, or FIT, it also checks for undetected blood in the stools but requires just a single sample. But rollout has been painfully slow.
My own practice began offering it only last year, and I’m aware that in some areas of the UK, patients are still being sent the old FOB test.
In August 2018, the UK National Screening Committee – scientists who evaluate the latest research on cancer detection – recommended that the screening age be dropped to 50. The original age, 60, was decided on based on the best evidence at the time.
But newer studies have shown that bowel-cancer risk really begins to rocket from the age of 50, making testing every two years from this age a no-brainer. The Government agreed to the new screening age.
The problem is, it still hasn’t happened. The NHS has said that many extra staff need to be trained to implement the change.
In the meantime, I keep seeing patients such as Karen, who are dying of preventable bowel cancer.
New test offered by just 50% of surgeries
This isn’t the only way the NHS is failing bowel-cancer patients. In 2013, a one-off test was introduced in some parts of England for people over the age of 55.
The bowel scope involves a thin tube with a camera being inserted in the back passage, to check for small growths called polyps, which could turn cancerous.
But only about half of all GP surgeries in England currently invite patients for the ten-minute test.
This means many over-55s miss out on a potentially life-saving check – and have to wait until they are 60 to be screened.
In Scotland, where the screening age is 50, twice as many cancers are picked up than were done using the old system, and four times as many pre-cancers, according to studies.
The Scottish system also has more people completing the test – an average of 64 per cent, compared to 50 per cent in England.
Every year, bowel cancer is responsible for 1,200 deaths in 50-to-59-year-olds – many easily avoidable.
Public health campaigns often focus on telling patients not to be ‘embarrassed’ to report bleeding, a sign of the disease.
But the truth is, without screening, it’s the Health Service that is failing the public.
Admittedly, with 7.5 million people in England aged between 50 and 59, reducing the screening age will incur extra costs for the NHS.
But perhaps, along with the Prime Minister’s promise of 6,000 new GPs, tens of thousands of new nurses and 40 new hospitals, he can also fund vital endoscopy and colonoscopy services, which diagnose bowel cancer after patients get concerning results from FIT or FOB test.
Extra costs may well be balanced by the savings made on expensive cancer treatments. And if health chiefs need more convincing, perhaps they’d like to meet Karen – while she’s still with us.
The M-Word: Everything You Need To Know About The Menopause, by Dr Philippa Kaye, is out now (Summersdale, £9.99).