New Zealand accused of dropping the ball on bowel cancer
Hundreds of Kiwis are ending up in emergency departments with undiagnosed bowel cancer, with a study showing patients in Australia are more likely to be treated sooner, and live longer.
The Auckland University study of more than 5000 bowel cancer patients – the biggest conducted in New Zealand – is likely to heap more pressure on the Government to push forward with national bowel screening.
It shows we are often slower to pick up bowel cancer is the case in Australia or Britain, decreasing the chances of treating it aggressively and making it more likely that patients will die sooner.
More than one in three colon cancer patients in the study were diagnosed only at the emergency department when they turned up in in pain. Survival rates for cancer, particularly bowel cancer, increase dramatically with early detection.
This flowed through to one in four colon cancer patients being diagnosed only at its most advanced stage, when cancer had spread and treatment was unlikely to work.
On both measures, New Zealand compared poorly to Australia and Britain.
Once the cancer was detected, patients were less likely to receive chemotherapy, even when there was good evidence it could extend their life. Maori and Pacific Island people fared even worse on most measures, including early detection and treatment.
Professor Michael Findlay, the study's principal investigator, said for the one in three bowel cancer patients turning up at hospital in bad way, it was often too late. "They are in big trouble."
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He believed the study showed that, even with all the education in the world, a national bowel cancer screening programme was needed, starting with training more people to perform colonoscopies.
"We have known about these problems for a while, so it would be good to train these people so we can get on with it."
Beat Bowel Cancer New Zealand also called on the Government to forge ahead with national screening, calling delays thus far "unfathomable", given our poor detection rates.
"We can't afford to wait for any election year for this decision. National screening is going to save hundreds of lives a year," executive member Sara Derrett said.
Professor Tony Blakely, who was not involved in the study, also supported screening but said there was "a huge amount of hot air" around poor bowel cancer rates. While we fared poorly in early detection, our survival rates were not much lower than Australia's, and far better than Britain's.
"It would be great to do as well as Australia, but we are not that far off."
Health Minister Jonathan Coleman was not available for interview, but said in a statement that the study would help with "ongoing improvements in the way we approach cancer detection and treatment".
He did not address specific shortcomings raised in the study, but said faster treatment of cancer was a "top priority" for the Government, reflected in targets for faster treatment set last year.
By the end of the year he hoped to take a case to the Cabinet for a possible introduction of a national screening programme in 2017.
The study was funded by the Health Research Council and the Ministry of Health.
CATCHING IT EARLY
Trish Cooney believes she might not be here if she had relied on the public system to diagnose her bowel cancer.
The 51-year-old Wellington nurse, and mother of two teenagers, went to see a private specialist after developing minor symptoms in 2013. She was quickly diagnosed with early-stage bowel cancer after a colonoscopy, referred back to the public system and had surgery to remove a tumour about three months later.
"When I went in, I wasn't even thinking about bowel cancer, so it was quite a shock," she said.
Cooney had the benefit of health training, a job that involved looking at a lot of colonoscopy results, and a few thousand dollars to pay for a private specialist. Few other bowel cancer patients are as lucky.
While the treatment under the public health system was excellent, the bar for detection was too high, she said. "With my symptoms, I would never had made it in public. It would have been another six to 12 months as things got worse."
Cooney supported national screening, which she believed would save lives and money, as early detection would cut the bill for chemotherapy and radiation treatment.
THE COMMON CANCER
* Bowel cancer is New Zealand's most common cancer, and only lung cancer kills more people.
* About 1200 people die of bowel cancer a year, roughly the number that die of breast and prostate cancer combined.
* World Health Organisation figures show New Zealand has one of the highest rates of bowel cancer in the world, and its survival rates are worse than Australia's.
* Unlike breast, cervical or prostate cancer, the bowel disease does not have a national screening programme in New Zealand. A screening trial has been running in Waitemata, Auckland, since 2011, with promising results, but a wider rollout has been delayed amid concerns that there are not enough specialists for national screening.
* Change of bowel motions over several weeks without returning to normal.
* Persistent or periodic pain in the abdomen.
* A lump or mass in the abdomen.
* Tiredness and loss of weight for no particular reason.
* Bleeding from the bottom, or seeing blood in the toilet after a bowel motion.