Below Helen Coleman discusses one of the greatest barriers to participation, our reluctance to discuss our bowels, and why it’s important that we get over it.
Helen Coleman, Queen’s University Belfast
Not all cancers are equal – especially when it comes to awareness. April marks the return of Bowel Cancer Awareness month in the UK. It always surprises me how reluctant we are as humans to talk about our bowels. Why can we talk freely about some body parts and habits but not others?
Bowel cancer ranks as the fourth most commonly diagnosed cancer in the UK, but it jumps up to the second or third leading cause of cancer death depending on where you live in the UK and whether you consider other cancers that affect only males or females. And yet bowel cancer is one of the few cancers that has a pre-cancerous growth, known as a polyp or adenoma, that can be detected and removed. So we have a clear opportunity to reduce our chances of both developing bowel cancer and dying from it.
The introduction of the NHS Bowel Cancer Screening programme in the past decade in other parts of the UK, and more recently in Northern Ireland, has been a welcome addition to our efforts to prevent deaths from bowel cancer. But our reluctance to discuss our bowels undoubtedly has a knock-on effect, making many less willing to do the test.
In Northern Ireland, men and women aged 60-74 (age ranges vary slightly in other parts of the UK) are sent packs every two years so they can complete the test at home. These involve collecting and handling small samples of faeces passed on three separate occasions, and posting these off to a laboratory where they are tested for occult (hidden traces of blood). Yet fewer than half of all adults who are sent these packs actually take them and send them back. This compares with uptake rates of 70-80% for both breast screening and cervical screening. And the poorer uptake isn’t a simple reflection of it being the only cancer screening test available for both men and women – although women are slightly more likely to take the test than men.
So why are we less likely to screen our bowels than other body parts? Research undertaken to understand the reasons behind this low uptake revealed many common factors for other cancers for which screening programmes exist, such as fear of cancer and the getting the results from the test. However, other bowel-specific reasons such as test procedures and disgust over handling faeces were raised. These trends have also been reported in other parts of the UK. How can we overcome such cultural beliefs and norms? Most people have changed nappies, or “scooped poop” when walking their dogs, at some stage of their lives. Apparently, it’s handling our own faeces that is the issue.
Here comes the bowelscope
If people do take the bowel screening test, and their samples reveal a positive faecal occult blood result, they will then be invited to attend a colonoscopy, which is the main method for detecting bowel polyps and cancer. Is the possibility of undergoing this invasive procedure also putting people off having the test? Perhaps, but cervical smear tests are equally invasive and we still see better uptake rates for cervical screening.
In England, 55-year-old men and women are soon to be offered a “bowelscope” – a type of colonoscopy called a flexible sigmoidoscopy that allows investigation of the left-side of the bowel. They will also then be invited to take part in bowel cancer screening tests from age 60 as per the rest of the country.
Flexible sigmoidoscopy screening tests have been shown to lead to better detection rates of adenoma and cancer than faecal occult blood tests, and it is estimated that bowelscope will prevent an extra 10,000 bowel cancer cases and 2,000 bowel cancer deaths by 2030, even if uptake rates remain at only 50%. However, bowelscope isn’t available in Scotland, Wales or Northern Ireland. So, when it comes to cancer awareness, not all cancers are equal. And when it comes to cancer screening, not all services are equal. Still, introduction of bowelscope in England should at least increase awareness of bowel cancer throughout the UK.
Efforts to lobby and increase awareness of digestive tract cancers, particularly bowel cancer, still lag well behind other cancer types. We don’t have an equivalent celebrity figure raising awareness of bowel cancer, as seen for some other cancer types. Although some campaigns such as “Lift the lid” and “Be cancer aware” are helping to change this for bowel cancer, we need to be more willing to discuss our bowels. At present, people are still literally dying from embarrassment.