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The cancer that dare not speak its name

Anita Tang

by Anita Tang

07 Apr 05:35am

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Filed under: Bowel Cancer, Breast Cancer, Cancer Screening, Colorectal, Public Health

34 comments

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.

OMG! You totes wouldn't believe what's in there!

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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34 comments

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    • Erick says:

      06:12am | 07/04/11

      I’m sure a nationwide bowel cancer testing programme would cost less than, say pink batts. The government’s budget is huge, and has a lot of fat in it.

      I didn’t know that prostate cancer was the third biggest cause of cancer deaths, and even kills more people than breast cancer. The huge breast cancer industry has obscured a lot of health facts. I wonder how many people’s careers and income depend on keeping pink ribbons in production?

      Reply

    • Carz says:

      08:00am | 07/04/11

      I don’t believe that the “huge breast cancer industry” has obscured the health facts. What they say is “Breast cancer is the most common cancer diagnosed in women aged over 35 years — 29% of all cancers diagnosed.” http://www.mydr.com.au/womens-health/breast-cancer-facts-and-figures  and “Breast cancer is the leading cause of cancer death in women between the ages of 15 and 54, and the second cause of cancer death in women 55 to 74.” http://womenshealth.about.com/cs/breastcancer/a/breastcancfacts.htm

      If you want a higher profile for Prostate Cancer awareness then get off your arse and fight for it instead of denigrating the great work that has been done for breast cancer awareness.

    • Erick says:

      08:02am | 07/04/11

      I did a few rough calculations on my way to work.

      If the cost of a bowel cancer scan is $30, and assuming there are five million Australians over 50, then testing all of the would cost $150 million. Since tests are only required every two years, that’s an annual cost of $75 million.

      The Federal Government’s annual budget is somewhere around $300,000 million, the vast majority of which is spent on health, education and welfare. So such a screening programme would use about one-fortieth of one per cent of the government’s budget.

      If regular testing saved the lives of half of those who annually die of bowel cancer, the cost would come to about $37,500 per life saved.

    • grumpy old man says:

      08:16am | 07/04/11

      Carz,
      the sad reality of life is that a women with breast cancer will always elicit more social support and sympathy than a man with prostate cancer.
      There are a number of organisations that do an incredible amount of fund raising for prostate cancer research and support groups, but they will never get anything like the free advertising that the breast cancer industry does. This is a simple fact of life, and no amount of “get off your arse “is going to change this.  I don’t believe Erick has said anything in his post that denigrates the work done for breast cancer awareness, he is simply pointing out the fact that more people die of prostate cancer than breast cancer, that the cost of bowel screening would probably cost less than the pink batts shambles, and that some have made a career out of pink ribbons.

    • Wayne Fehlhaber says:

      09:39am | 07/04/11

      Grumpy Old Man :  You are right on the money and i agree fully with your comment.  In fact , i have raised the same facts in this column in the past and was told , by a woman , precisely what you refer to as a common reaction ” get off your arse. ” The subject was prostate cancer.

      Bowel cancer in both genders , faces the same problem as prostate cancer , cannot elicit the interest or support necessary to make inroads into treatment and prevention of the disease.

    • Bev says:

      10:30am | 07/04/11

      Carz says:08:00am | 07/04/11

      I don’t believe that the “huge breast cancer industry” has obscured the health facts
       
      Fact is the feminist womans health lobby has muddied the waters and has managed to secure an enormous slice of the health dollar, spending on awareness campaigns, research and treatment of womens cancers. They lobby hard to maintain it at the expense of everything else. Cervical cancer and ovarian cancer are prime examples.  Even though these cancers are way down the list of cancers and effect small numbers of women enormous amounts of money are spent on awareness and research, money which could be more usefuly spent elseware.

      Your comment is typical of feminists who think only of themselves and want their selfish and self centred needs, wants and desires met and to hell with everybody elses.

    • john says:

      01:24pm | 07/04/11

      @Erick, who cares, as long as we have our priorities right and spend 100 billion dollars {after costs blow out} on the NBN first.

      ...and if you believe what I just said your a ‘monkey’s uncle’

    • Carz says:

      02:14pm | 07/04/11

      Geez, us nasty old feminists really have a hand in screwing up life for everyone else, don’t we? You didn’t stop to think that perhaps the breast cancer crusade was started by people who saw a problem and got up and did something about it? Or that they see a problem in the fact that most ovarian and cervical cancers were detected too late for a cure and decided that was a problem, so they got off their arses and did something about it?

      The simple fact is that sitting back and whining doesn’t get things done. If you aren’t happy with the way things are then you have to be prepared to do something about it yourself. Lobby your government, the health industry, make enough noise to get yourself noticed by the media. These things encourage change in a way that moaning and complaining never will. That is why the feminists, love them or hate them, have managed to do what they have.

    • mike j says:

      04:16pm | 07/04/11

      Heard of Glenn McGrath, Carz? He got off his arse.

      http://www.mcgrathfoundation.com.au/

      Glenn’s attitude is characteristic of men, to whom the welfare of their partner and loved ones is often a higher priority than their own.

      Your attitude, by contrast, is characteristic of women, who only care about themselves.

    • Carz says:

      04:53pm | 07/04/11

      @ mike j, of course I have. I have also heard of Micheal J Fox, who, with his foundation has raised huge amounts of money that has gone directly to funding research into Parkinson’s Disease. I have heard of Christopher Reeve, who raised the profile of both spinal cord injuries and stem cell research. And your comments prove my point; getting up and doing things is what makes a difference. And please don’t assume to know me and what I care about.

    • Bev says:

      05:29pm | 07/04/11

      Carz says:02:14pm | 07/04/11

      Geez, us nasty old feminists really have a hand in screwing up life for everyone else, don’t we?

      Yup. 
      In 2006:
      there were 3809 deaths from colorectal cancer.
      there were 2971 deaths from prostate cancer.
      there were 2625 women and 25 men deaths of breast cancer.
      there were 810 deaths from ovarian cancer.
      there were 227 deaths from cervical cancer.
      Ovarian cancer is the 9th most common cancer in women
      If we sum cancers that only effect women we get 3662 deaths.
      Less than the number of men and women killed by colrectal cancer.

      Despite this the feminist lobby demands more and more.  There was an article in the punch some time ago. One women commented that at a meeting about prostrate cancer awareness feminists turned up and shouted down speakers and tried to hijack the meeting so it talked only about breast cancer.  This is what anybody who tries to raise awareness of male or other cancers is up against. Plus only feminists have the ear of the Minister for women and major input to the health minister others dont.  So all your talk about getting off arses is so much hot air.  Yet despite feminist objections other cancer awareness is rising and many men and women are utterly sick of feminist cancer campaigns and taking their donations elseware.

    • mike j says:

      06:08pm | 07/04/11

      I’m not making any assumptions, Carz. Your attitude is self evident.

      Nor should one have to ‘get off one’s arse’ to expect the equitable distribution of public monies and political awareness.

    • Carz says:

      06:58pm | 07/04/11

      @ mike Public monies is one thing but you can’t deny that a hell of a lot of the money that goes towards research and awareness comes from private donations for precisely that cause. Are you suggesting that all that money should be split evenly between the cancers? As for self-evident, my shaved head isn’t because I am a radical feminist. It was to raise money for the Leukeamia Foundation and show support for the family of a MAN I know who has a blood cancer.

      @ Bev, you are talking about one type of feminist. Like people there are many types. Personally I find that hijacking a forum like you described abhorrent. Those people should have been ejected immediately. And it also doesn’t say much for whoever was moderating/leading the forum if they allowed it to happen.

    • Ritchard says:

      06:39am | 07/04/11

      Wow,
      I’m amazed, There was something you didn’t know?
      Tell us more about the pink batts.

      Reply

    • Harry says:

      10:13am | 07/04/11

      If councils didn’t insist that people paint their roofs black (attracts heat) we wouldn’t need pink batts.

    • Jim says:

      07:35am | 07/04/11

      I’m certain most medical research institutes in this country would love to get a fraction of the $8bn or so earmarked for overseas diplomatic relations - err, I mean foreign aid.

      I reckon it would be used a whole lot more honestly too!

      Reply

    • Carz says:

      08:02am | 07/04/11

      No, bowel cancer isn’t sexy, but then what cancer really is. What it needs to raise awareness is for a few high profile people who have survived it to come out and speak about it. Maybe then we would start to see some of the same awareness that we do for breast cancer, leukaemia and other blood cancers and childhood cancers.

      Reply

    • hermano says:

      08:09am | 07/04/11

      Also kind of amazing is that more men than women will get cancer.  Can’t remember the exact figure, but something like 2/3 of men and 1/2 of women.  Yet there’s so much public emphasis on breast cancer.
      I was diagnosed with testicular cancer about 3 weeks ago and had the tumour and one teste removed the other week.  Apparently 97% survival rates when caught early (which I’m pretty happy about), and it’s not an uncommon thing for youngish blokes to have this kind of cancer.  Yet it hardly rates a mention in the media, even though it’s common and curable.
      Maybe if a high-profile sports star or celebrity contracted bowel cancer and went public there could be greater push for awareness.  Worked with Jane McGrath.
      Now if you’ll excuse me, I’m off to train for the Tour de France…

      Reply

    • Bev says:

      10:05am | 07/04/11

      I can walk into the chemist shop and obtain a pamphlet on breast self examination.  Breast self examination is highly publicized and most are aware of it.  However the same cannot be said for self examination for youths and young men. I obtained the information (http://www.mydr.com.au/mens-health/testicular-self-examination-tseand) gave it to my son so he could pass it on to his boys. While there is a seeming bottomless bucket of funding available for awareness campaigns for women’s cancers (breast, cervical and ovarian) there are no (or very little) money available for awareness and research for other cancers.  One would think the AFL and NFL would be interested in promoting awareness of testicular cancer since it affects mostly youths and young men but it seems they are only interested in Pink Days. Surely production of posters for distribution to sporting club change rooms is not a difficult or wildly expensive exercise.

    • Marty says:

      08:26am | 07/04/11

      I had no idea about the stats of mortality rates for cancer.  Not attempting to denigrate the work of the spectacular Pink Ribbon marketing campaign, I’d be interested to know what the mortality rates versus incidence rates are for the top five cancers versus pre-Pink Ribbon.  Was mortality significantly higher previously (scaled) amongst the four types listed which is why breast cancer is now fourth post-awareness campaign?

      Reply

    • Stiffy says:

      08:35am | 07/04/11

      A Gastroenterologist has a s**t of a job.

      Reply

    • Neilly G says:

      09:25am | 07/04/11

      Then what kind of job do you think a gynecologist has?

    • E says:

      10:50am | 07/04/11

      My dear friend died of bowel cancer (which also spread to her stomach and liver in the end) around 4 years ago, 3 months after her 24th birthday. 3 months from diagnosis to death. Please, get regular check ups, and do all you can for yourself health-wise. If something seems wrong “in that area”, please swallow your embarrassment and see a doctor. You can bet they’ve seen worse, a thousand times over. It could save your life.

      Reply

    • Kelvin says:

      11:35am | 07/04/11

      Great follow-up article to Tory’s piece yesterday Anita!
      The Federal Government has completely abrogated its responsibility to the community at large by terminating the National Bowel Cancer Screening Program.

      Nicola Roxon as the Minister responsible has to be held personally accountable for this and the resultant increase in mortality rate from Bowel Cancer. It will, by her own department’s statements add up to 1300 unnecessary preventable deaths from bowel cancer each year.

      4 deaths from Pink Batts brought down the Minister in charge of that disaster - what should this do to the Health Minister?

      Contact you MP and let them know your thoughts. Its easy thanks to the Cancer Council Get Behind Bowel Screening web site: http://www.getbehindbowelscreening.com.au/government/default.asp?ContentID=government

      Yesterday the Cancer Council asked for some suggestions about how to increase the profile and awareness of Bowel Cancer. Here are some thought starters for you:
      •  Be well coordinated and get aggressively and persistently into the media to get the facts of the disease known. Most don’t know of any symptoms to look for. Unfortunately too many people think that breast cancer is the be all and end all of cancer in this country.
      •  Start referring to it by the name – COLON Cancer – it may help to move the disease away from the ‘gross bowel’ syndrome that is seemingly attached to the name bowel cancer. Surely it would help move away from some of the puerile comments that some persist in making to trivialise the issue.
      •  Match colon cancer and an associated promotional campaign up with an appropriate symbol and or colour (not brown as people immediately suggest.) Why not green or red – I don’t think they are taken.
      •  Raise the media pressure on the federal government to unequivocally commit to a long term national screening program. Peter Dutton and Tony Windsor went to the bowel cancer breakfast that the Cancer Council had in Canberra – where was Nicola Roxon?
      •  The department of health and aging are good at advertising campaigns and launching web sites (they have 19 that cost a fortune and cover most issues less important than this) – lobby them to run an advertising campaign and launch another web site that outlines the facts about the disease but in particular to highlight the symptoms of the disease as I will guarantee that only people touched by colon cancer would have any idea of what constitutes a symptom.
      •  Create some media ‘stunts’ like Katie Kouric and then Harry Smith of the CBS Early show did where they both (at an interval of several years) had colonoscopies televised live on national TV in America. – Why not get Kochie or Berets colonoscopied as part of Sunrise – they are pretty committed to the cancer cause. Have a look at the clip here http://www.youtube.com/watch?v=zLAPQdlXgdU
      •  Lobby the current affairs programs to run stories about the disease. There must be thousands of human interest stories about it. Today Tonight did one a few weeks ago about a person who renovated a colon cancer snuffers’ house. Really touching story but all they focused on was the human interest side – not how to notice, diagnose, treat the disease as a follow up which would have been the real story.
      •  Ray Hadley is a big supporter of awareness of colon cancer – get him involved in talking about it to highlight –
      o   the prevalence of bowel cancer
      o   the symptoms of bowel cancer and early warning signs
      o   preventative measures you can take to reduce your risk
      •  Create a month long event to highlight awareness – rally those touched by colon cancer to get involved. Unfortunately you will have to make an investment in much the same was as the breast cancer people have done to create their wonderful pink ribbon (and make everything else pink for that matter) campaign.
      •  Raise the subject of awareness of the disease with the nation’s top sporting bodies and enlist their support. The power of the AFL, NRL, ARU, Cricket Australia, Swimming Australia, Tennis Australia is immense if harnessed properly.

      Reply

    • Pinky says:

      12:15pm | 07/04/11

      Dont smoke idiots.

      Reply

    • Erick says:

      01:22pm | 07/04/11

      I tried smoking idiots, but they wouldn’t stay alight.

    • Weary says:

      02:37pm | 07/04/11

      Don’t talk idiot.

    • eck says:

      12:55pm | 07/04/11

      pinky…you’re the idiot…. sheesh. non smokers can also get bowel cancer

      Reply

    • josh says:

      06:33pm | 07/04/11

      Yes, but if that’s from where you smoke…...

    • Government Healthcare is a Joke says:

      01:05pm | 07/04/11

      Didn’t the government scrap the bowel screening programme because (like everything else they do) they stuffed it up?

      “ALMOST half a million people have been given faulty bowel cancer screening kits and more than 100,000 who have been cleared of the disease will have to take the test again in the latest debacle to plague the Federal Government’s screening program.”

      http://www.smh.com.au/national/cancer-bungle-recall-20090511-b0kp.html

      How many of those half-million people who were told they didn’t have any signs of cancer will actually get re-tested?  And if any of the half-million told they didn’t have any signs of cancer actually DID have cancer, can they hold the government responsible?

      What a disaster.

      Reply

    • Cameron England says:

      02:49pm | 07/04/11

      Fundraiser suggestion: Date Night! Thank you, thank you, I’ll be here all week, try the veal.

      Reply

    • Geoffo says:

      10:38pm | 07/04/11

      Terrific contemporary look at a long time killer Anita . I am 50, long time Iover of all meats and seafood…  and I participated in the recent Fed Government Bowel Cancer Kit mailouts. I did the test and , sort of embarrassing as it might be to some ,  waited , interested and somewhat worried too . My test came back negative faecal blood which relieved me greatly smile  I will say though that I waited till almost the deadline for the free test and am glad I took it . I hope this is repeated for the next generations too and anyone over 40 should do a test at latest due to all the fast food out there now ..  ( footnote .. i am a great believer in using onions and garlic in my diet more than 3 times a week . After the test,  I now cook at home more than ever before and use less oils, and I use a wok on most occasions for crisp vegetables and lean cooking )

      Reply

    • Elizabeth says:

      05:15pm | 12/05/11

      Womens’ cancer screening is highly political with lots of vested interests and thus gets most of the money. Cervical cancer screening sends 77% of Aussie women at some stage for colposcopy/biopsies (almost all are false positives) to cover a 0.65% lifetime risk of cervical cancer - huge over-detection and potentially harmful over-treatment. This screening always seems to escape scrutiny, but it harms FAR more than it helps. There are no randomized controlled trials for pap testing, so we’ll never know if it helps anyone, but we do know, if it does, it’s fewer than 0.45%...at least a third of women who get cervical cancer are false negative cases and we know lots of other factors are naturally reducing the incidence/death rate - more hysterectomies, better condoms, less STD, better hygiene, fewer women smoking, better immune systems with improved standard of living…
      CC has always been rare and was in natural decline before screening started…Dr Angela Raffle, UK expert tells us that 1000 women need regular screening for 35 years to save one woman from cc. (BMJ; 2003 - also see commentary at “Why I’ll never have another smear test” by Anna Saybourn.) Huge numbers of healthy women are worried and harmed over that time.
      We spend tens of millions on this screening plus all of the unnecessary biopsies treatment and caring for women left with problems after unnecessary cone biopsies and procedures like LEEP. Cervical damage can mean infertility, cervical stenosis, cervical incompetence - miscarriages and premature babies etc.
      Our program is especially bad as we test women under 30 - “no country in the world has shown a reduction in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical cancer screening”  (“Cervical cancer screening” in “Australian Doctor” 2006 by Assoc Prof Davy and Dr Shorne)  BUT this group produce huge numbers of false positives. It is unethical to screen young women. (Dr Raffle’s research also relevant here) Also, 2 yearly screening is over-screening which increases the risks - Finland have the lowest rates of cc in the world AND just as importantly, sends the fewest number of women for colposcopy/biopsies, they offer 5 yearly testing from age 30.
      This hugely expensive program harms FAR more than it helps - time for someone to stand up and make some ethical and rational decisions.
      Very few women are giving informed consent for cervical or breast cancer screening - it would be impossible given the quality of the “information” that is provided in the screening brochures. Also, doctors should not be paid to reach targets for pap tests - this puts our doctors in a potential conflict of interest. (Financial Incentives Legislation) These payments are not disclosed to women and are unethical.
      We need to spend more on bowel cancer screening, mental health and areas where far more lives could be saved….
      Breast cancer screening - once again, women get no real information, there is no respect for informed consent - after decades of research the benefits of this screening are still controversial. Listen to Prof Michael Baum’s lecture online at the Medphyzz site (Prof Baum is a UK breast cancer surgeon), “Breast cancer screening: the inconvenient truths”. The Nordic Cochrane Institute after criticizing Breast Screen’s brochure have produced a balanced information sheet for women, “The risks and benefits of mammograms” is at their website. Over-diagnosis is a serious problem with breast screening.
      I’ve made informed decisions not to take part in cervical or breast cancer screening on the basis of information that is not released to women.
      That is unacceptable - every woman has the right to make her own informed decisions about testing.  A double standard exists - men get risk information and there is respect for informed consent, women get puff and spin and an order to screen, even coercive and unethical measures are overlooked…the entire emphasis is on reaching Govt-set targets. 
      Real information is available though - Dr Joel Sherman’s medical privacy forum under womens’ privacy issues has a list of journal articles in the side bar. Also, the Violet to Blue site.

      Reply
 
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