The cancer that dare not speak its name
Yesterday, Tory Shepherd wrote a Punch piece on how breast cancer was beating bowel cancer in the cancer wars. Here, Anita Tang looks at why bowel cancer has an image problem and what should be done about it.
It’s not surprising bowel cancer has an image problem. What’s our emotional response to the word ‘bowel’? The bowel conjures images of the body’s secret inner workings; internal systems we would rather ignore. It connotes words we would rather not hear: colorectal, anus, intestine, canal and colon.
The bowel is not sexy. People don’t want to talk about it. However, bowel cancer is our second biggest cancer killer. It claims more than 4000 Australian lives each year, second only to lung cancer, which causes about 7600 deaths.
When we asked the public to name the two cancers which cause the most deaths in Australia, people said breast and lung. Only one in four listed bowel cancer. Given bowel cancer’s low public profile, it’s understandable people assume breast cancer kills more. In reality, breast cancer comes fourth, claiming around 2700 lives (prostate cancer is third, causing more than 2900 deaths annually).
Breast cancer survival rates have a comparatively good track record in Australia. Mortality is relatively low compared to incidence: about 12,670 cases (one death for every five cases) Why? There is a national free screening program for women aged over 50, supported by high awareness of breast cancer thanks to excellent PR and marketing campaigns. This means breast cancer is often detected early and can be successfully treated.
The poor bowel has not been so lucky. There were 14,234 cases diagnosed in 2007 (the latest national data). One death for every three cases diagnosed. Bowel cancer has not, as yet, captured the public’s imagination. It does not have a legion of popular ambassadors at its front. There are no supermodels, pop stars or sportspeople selling the bowel cancer story. We are told by journalists: “It’s not a story for breakfast”. There is no ribbon for bowel cancer; there is no agreed colour to unite the cause. And, most importantly, there is no national screening program.
Currently, one in five bowel cancers is diagnosed at stage four, the most advanced stage, when the cancer is often terminal. This is particularly tragic given bowel cancer is easy to treat when detected early. It is a double blow to those dying of the disease to learn there is a simple $30 test that can pick up the cancer early.
The Government’s own expert advisory group, the National Health and Medical Research Council, recommends that people aged 50 and over are screened for bowel cancer every two years. The cheapest and most effective way to do this is with an FOBT kit, mailed to Australians on their 50th birthday and subsequently every two years.
It requires participants to scrape a stool sample with a stick, place into a tube and send back for testing. Yes, the test sounds icky. But then so is cleaning the toilet or picking up your dog’s faeces. The difference is this simple, cheap test would save between 500 and 1000 lives each year.
A national screening program also makes economic sense. A study published this year in the Medical Journal of Australia concluded biennial screening for people aged 50–74 years would be “very cost-effective”. On the basis of lives saved and cost offsets elsewhere in the health system (treating advanced bowel cancer is highly expensive) it’s the best unrealised investment in cancer control the Government can make.
There is little argument against a national screening program, so it’s unacceptable that we have been talking about implementing a program for 15 years now. In comparison, the BreastScreen program only took five years to implement.
The bowel screening program was partially implemented from January 2006 but no new participants have been sent kits since 31 December 2010, and there is no commitment from the Government for funding beyond the current financial year. We now wait with bated breath as the Government remains silent on its plans, despite the Minister for Health, Nicola Roxon, admitting the ‘gold standard’ would be for every person over 50 years to be screened every two years.
Bowel cancer may need a public relations overhaul to make it relevant to breakfast TV.
But despite its image problem, there is a very real and immediate step the Australian Government can take now to reduce deaths from bowel cancer: Include funds for the national bowel cancer screening program in the Federal Budget. Further delays to the program mean more Australians are told each day they have a cancer that could have been treated if caught early, but is now likely to kill them.
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