What is bowel cancer?
The most common cancer in Australia (after skin cancer)
This cancer develops silently over years from uncontrolled, wart-like growths on the inner surface of the large bowel called polyps
Removing pre-cancerous polyps prevents bowel cancer
90 per cent of bowel cancers can be treated successfully, if detected early
Who is at increase risk of getting bowel cancer?
- Before 85 years, the lifetime risk in Australia is:
1 in 10 for men 1 in 15 for women
- Risk increases with age
- Men tend to get it 5-10 years earlier than women
|Approximate risk over the next….|
|If a person is aged||5 years||10 years||15 years||20 years|
|30||1 in 7000||1 in 2000||1 in 700||1 in 350|
|40||1 in 1200||1 in 400||1 in 200||1 in 90|
|50||1 in 300||1 in 100||1 in 50||1 in 30|
|60||1 in 100||1 in 50||1 in 30||1 in 20|
|70||1 in 65||1 in 30||1 in 20||1 in 15|
|80||1 in 50||1 in 25|
Bowel cancer risk is higher for people who have:
- blood passed during a bowel motion
- changes in bowel habits lasting more than two weeks
- prior bowel cancer or polyps
- a family member with bowel cancer or advanced polyps
- colitis for more than 10 years
Do I need bowel cancer screening if I have no symptoms and no family history? YES
- Just by living in Australia, we have the third highest risk of bowel cancer in the world (after Slovenia and New Zealand)
- Bowel cancer is most common in people with no symptoms and no family history
- It is Australia’s forgotten, most common, life-threatening but preventable cancer
- If you wait for symptoms, it may be too late to cure
- Earlier detection save lives and improves outcome
- One of the easiest cancers to catch early if screened at a preventable and curable stage (at polyp stage or before symptoms)
- There are several safe, acceptable and effective screening tests available
What screening options do I have after I turn 50? – there is no perfect option
Option 1: Faecal Occult Blood Test every 1-2 years (FOBT stool test) +/- one lifetime colonoscopy at 60-65 years old
- Conveniently done at home, this non-invasive, inexpensive test, detects “invisible” bleeding of early stage “silent” bowel cancer or polyps
- Bowel cancer or polyps may bleed silently for several years. The only way to find this silent bleeding is with a FOBT stool test.
- On a 15 year program, it decreases your chance of dying from bowel cancer 1% per year if you check a FOBT every 2 years and 2% per year if done annually. Namely, it is proven to decrease bowel cancer death by 15% if repeated every 2 years or 30% if repeated annually over 15 years respectively.
- 1 or 2 negative FOBTs is not an “all clear”. Negative test may still have a cancer or polyps. You must stay in the program for over 10 -15 years to be worthwhile
- positive FOBT = bowel cancer only 3-5%. All positive FOBTs need colonoscopy to investigate cause.
Option 2: Colonoscopy every 10 years (starting age: 40 if family history, 50 men, 55 women)
- most accurate, well tolerated and probably the most effective
- proven decrease bowel cancer death by at least 50%
- needs bowel preparation, 2-4 hours in day hospital, sedation
- most costly, 1 in 500 may have a serious complication
- negative test does not exclude polyps or cancer in 100%.
Option 3: Flexible sigmoidoscopy every 5 years plus FOBT
- This is a common choice in the UK.
- accurate, avoid large volume bowel preparation, no sedation
- only examines left side of bowel where most bowel cancer is found and to decrease risk of missing right-sided lesions do FOBT
- 1 in 15000 may have a serious complication
Option 4: CT- colonography every 5 years
- accurate and easy to perform provided reporting doctor is experienced
- may miss small polyps, needs bowel prep, may be uncomfortable
- radiation dose = 350 Xrays
- need colonoscopy for polyps
- often find irrelevant lesions which bring further worry and require followup testing and scans for month/years
Is bowel screening for me?
- If you are 50 years or over, bowel cancer screening may save your life
- Australians are being invited to take part in a new Government funded program using the “FOBT every 2 years” option to be fully implemented in 2020
- Over 70% of Australians have probably had some form of bowel cancer screening.
- currently over 60% (even when offered FOBT screening) do not take it up. This is partly why we have not seen a significant decrease in bowel cancer deaths in Australia since the 1960s.
- Many people who come to a specialist favour colonoscopy every 10 years (or every 5 years if there is a family history). There are also many who choose the less invasive, convenient FOBT stool test at home every year (or two).
- Screening for bowel cancer, when you feel well, have no symptoms and have no family member with bowel cancer, is a preventative health decision.
- Other examples include: asking a doctor for a‘flu shot or to check your blood pressure or sugar level for diabetes, or an annual skin check for skin cancers, or for women, a mammogram for breast cancer or pap smears for cervical cancer or, for men a prostate examination
- Talk your decision over with your doctor. Encourage the people close to you over 50 to do the same. Each option has a set of benefits and risks. None is 100% accurate. Any form of bowel cancer screening may save your life or a loved one and is better than waiting until it is too late.
“Are you over 50?
… then you are at significant risk for bowel cancer.
As Australians we are number 3 in the world rankings after Slovenia and New Zealand”
“Deaths from bowel cancer have not fallen much since the 1960s.
Don’t die from embarrassment. Screening saves lives.”