During June, Bowel Cancer Awareness Month, around 30 New Zealanders under the age of 50 will be diagnosed with bowel cancer. These diagnoses are happening too often, and often too late. Yet when caught early, bowel cancer is more than 90% curable, so awareness of the symptoms is so important – and the government needs to do more.
When we think of cancer, we might first think of breast cancer, skin cancer or lung cancer. But why don’t we talk more about bowel cancer? Or is that sort of self-explanatory? Conversations surrounding this part of our body are often considered yucky, embarrassing, even taboo. Social stigma and embarrassment is one of the main reasons many people don’t talk openly about bowel issues. And sure, your bowel motions probably aren’t something to bring up at the dinner table.
But we have to get past any squeamishness, and talk about poo. Why? Because we need to normalise talking about bowel cancer and its symptoms, so we know what to look out for – and visit a doctor early.
Bowel cancer is the second-deadliest cancer worldwide, and New Zealand has one of the highest rates of bowel cancer in the world. Every year, around 3300 New Zealanders (that’s around nine per day) are diagnosed with bowel cancer, and each year around 1200 New Zealanders (around four per day) die from the disease.
In recent years, the rates of bowel cancer in people aged under 50 (early-onset bowel cancer) have been increasing dramatically internationally. We’re leading the world in a way we don’t want to. Rates of bowel cancer in people under 50 are growing faster in New Zealand than anywhere else in the world. Each year in our country, around 350 people under 50 are diagnosed with early-onset bowel cancer. For New Zealanders in their 20s, 30s and 40s, bowel cancer is the number-one cause of cancer death.
Scarily, it often goes unrecognised until it is advanced. Yet when caught early, bowel cancer is more than 90% curable – it’s one of the most treatable cancers.
That’s why awareness about symptoms is so important.
Get Checked
See a GP promptly if you have: blood in your poo, ongoing changes in bowel habits, unexplained weight loss, persistent tiredness, abdominal pain or a lump in your tummy. Do a two-minute online symptom checker here and be in to win a ‘poo with a view’ getaway: choose from one of 10 scenic loos in the country, and get nearly $5000 towards a holiday in that area. More importantly, the online check will direct you to see a doctor if needed.
If you feel like your GP is brushing off your concerns, get a second opinion. Push for a referral letter to get a colonoscopy in the public-health system. Unfortunately, you often have to advocate hard for yourself.
Thankfully, there’s also an organisation doing advocacy and that you can get in touch with.
Bowel Cancer New Zealand is a nationwide charity dedicated to awareness, advocacy, research, prevention, early detection, and supporting New Zealanders living with bowel cancer and their families. It’s also fighting for equitable and timely access to the best possible screening, treatment and care.
Never Too Young
In February, Bowel Cancer NZ launched its Never Too Young Report at Parliament. Hosted by MP Sam Uffindell, the evening brought together Minister of Health Simeon Brown, representatives from Te Whatu Ora Health New Zealand and from the Ministry of Health, researchers, patients, and supporters.
The report is an important national snapshot of what it’s like to face bowel cancer young. More than 350 New Zealanders under the age of 50 shared their stories. Their voices revealed long delays to referrals, late-stage diagnoses, and inconsistent access to testing.
The report found that half of the respondents didn’t know the symptoms of bowel cancer before diagnosis. Shockingly, 44.5% saw between two and five healthcare providers before they got diagnostic testing, and 14% waited more than a year for testing. While 89% were working at diagnosis; 45% had to stop work at lest temporarily.
Respondents told of the huge emotional and financial toll of being diagnosed during life’s busiest years. Fear. Fatigue. Finances. Families. Fertility. Two-thirds of respondents reported ongoing fatigue, anxiety and/or depression, and many described a negative impact on body image and their relationships.
Reverse Ageism?
“This report gives a voice to hundreds of New Zealanders who should never have had to fight this hard to be taken seriously,” says Peter Huskinson, Chief Executive of Bowel Cancer NZ. “Too many were told they were ‘too young’ for bowel cancer – and by the time they were diagnosed, it was advanced [for many].”
Their voices highlight an urgent need for earlier detection, easier and more equitable access to testing, and greater awareness among the public and healthcare professionals including GPs.
There’s a sort of reverse ageism going on. The report highlighted that, even with prompt colonoscopies, people under 50 are likelier to be diagnosed at a later stage (than older patients are). But people of all ages should be taken seriously when they report symptoms to a doctor.
“By listening to the voices in this report,” Huskinson says, “we can make earlier diagnosis the norm – not the exception”.
Screen Time
New Zealand has a National Bowel Screening Programme. Once you hit the eligible age (currently 58), Health NZ automatically sends you a bowel-screening testing kit. You’re sent a kit every two years until you turn 75. (It’s important to remember screening is for people without symptoms; anyone experiencing symptoms should see their GP regardless of age.)
The screening kit’s faecal immunochemical test can detect tiny traces of blood in stool samples. This test picks up bowel cancer in 7 out of 10 people who have it at the time of screening. At least 40% of the cancers detected are early stage, when they can often be successfully treated.
Last year, the government lowered the eligibility age from 60 to 58. In September, this will drop to 56. The government estimates this will make a further 122,000 people eligible for free screening and, over 25 years, help prevent an additional 771 bowel cancers and save 566 lives.
Huskinson says BCNZ welcomes the step. “This change will save lives and prevent cancers, but we know more needs to be done.”
“Our clinically backed, costed plan to begin screening at 45, shared with the government earlier this year, would detect six in ten early-onset bowel cancers before symptoms develop – at an earlier, more treatable stage.”
The report showed that a third of its respondents would have been eligible for testing if the eligibility age had been lowered to 45, in line with Australia and other international programmes.
Professor Frank Frizelle, medical advisor to Bowel Cancer NZ, and author of the foreword in Never Too Young report, is a colorectal surgeon who diagnoses younger people with bowel cancer far too often. “Early-onset bowel cancer is increasing, and our systems must respond. The commonplace delays in diagnosis in New Zealand are not inevitable – they are addressable. Screening at 45 will make a significant contribution to saving lives.”
While screening saves lives, it only helps those who are eligible and who have no symptoms. That’s why symptom awareness remains so important.
Doing More
Huskinson says the approach to prevention, diagnosis and care for bowel cancer in New Zealand has lagged far behind the standard we rightly expect for other cancers. “Currently, New Zealand has no clear strategy to address the public-health emergency of early-onset bowel cancer. This report provides an opportunity to change that – if our health leaders, policymakers and politicians will listen and act. There are improvements needed at every stage of diagnosis and treatment, but first we must act to prevent and detect this disease earlier.”
It’s a public-health issue warranting an urgent, coordinated government response.
Younger people must be considered more, the report says. “Bowel cancer is the leading cause of cancer death among New Zealanders under 50 – and up to half of these deaths are preventable. Yet it continues to receive little public attention, limited investment, and almost no national discussion about prevention and testing. Why is more not being done to protect a generation of young New Zealanders?”.
Risk Factors
Hereditary factors may be identified in approximately 30% of those diagnosed with bowel cancer, but 70% of people have no family history.
Risk factors include obesity, a lack of exercise, excess alcohol consumption, smoking, and a diet that is low in fruit and vegetables and high in red meat and fast food. However, it’s uncertain whether these factors are driving a specific increase in early-onset bowel cancer.
What’s certain is that we need to look out for symptoms, and have easier and equitable access to testing and treatment. Plus, let’s have conversations. Because talking about poo should not be taboo.
