Path of least resistance taken on bowel screenings

Effective bowel cancer screening is about so much more than the initial test. PHOTO: SUPPLIED
Effective bowel cancer screening is about so much more than the initial test. PHOTO: SUPPLIED
Do not imitate the gullible grandmother.

That’s my advice to political leaders participating in debates.

The gullible grandmother succumbs to pressure when shopping with grandchildren who want things which she a) cannot afford b) thinks are crap c) knows the parents would abhor, or all of the above.

She takes the path of least resistance without considering the consequences.

In last week’s Three television leaders’ debate, Paddy Gower, playing the part of the demanding grandchild, but thankfully without tears and foot stamping, badgered both National leader Christopher Luxon and Labour’s Chris Hipkins into committing to lower the starting age of bowel screening to 50.

The existing programme covers 60 to 74-year-olds.

You might think this would be a hallelujah moment for me.

My husband died before the age of 50 from bowel cancer and I know how an effective bowel screening programme can prevent cancers developing and save lives.

But I consider it irresponsible of both leaders to make such promises on the hoof, raising expectations unrealistically.

I suspect both have little understanding of how much it would cost, and what would be involved.

I would be surprised if either of them could organise it in the next three years.

The extension of the programme to 50-year-old Māori and Pasifika people began with Waikato and Tairāwhiti after $36 million was allocated in last year’s Budget, and is expected to be extended throughout the country to about 60,000 people.

This acknowledges the higher proportion of Māori and Pasifika who contract bowel cancer before 60, and their shorter life expectancy, which means they have fewer years to gain from bowel screening beginning at 60.

Should we introduce and evaluate that fully before going further?

It might seem easy enough to send out thousands more test kits to people, but effective screening is about so much more than the initial test.

It would be unethical to expand the programme to 50-year-olds if the system could not cope in a timely manner with the extra lab testing, colonoscopies, surgery and other treatments which might be needed.

Talking of ethics, do either of the Christophers know whether we are keeping up with demand for colonoscopies for those outside the programme exhibiting symptoms which might be bowel cancer?

Such colonoscopy figures are collected and collated but no longer publicly reported as they used to be, Te Whatu Ora Health New Zealand tells me, but I am unsure if they include decline rates.

It is not unusual to see cases reported in the media where symptomatic people have struggled to get timely diagnosis, and with an increasing number of under-50s getting the disease, anything which might make diagnosis harder for them is unacceptable.

In the Southern area, where access to colonoscopy for symptomatic patients had been difficult for years, concerns remain about the harm from that rationing and whether the district health board should have joined the screening programme before sorting out that access.

During the television debate, there was mention of matching the Australian programme which offers screening from the age of 50 to 74, and at 45 on request.

However, if we are wanting to emulate Australia’s programme, we would also need to beef up our blood/poo test.

In Australia, the amount of blood found in a poo sample which would trigger referral to a colonoscopy is half that of our programme — the level here is 40 micrograms of haemoglobin per gram of faeces, compared with Australia’s 20ug Hb/g.

In the Waitematā pilot programme, where screening was offered to 50 to 74-year-olds, the threshold used was even more sensitive than the Australian one at 15ug Hb/g.

However, although there was much reluctance by health officials to be upfront about this, when making the transition to a national programme, it was recognised the demand for colonoscopy would be more than the health system could cope with if both the age and the threshold remained the same as the pilot. (It is estimated only 62% of people found with cancers in the Waitematā pilot programme would have had them detected if the pilot had used the age range and blood/faeces test level of the national programme.)

Another vital aspect of screening programmes is comprehensive independent evaluation and monitoring.

This has not been done for the national programme and, from my queries about this, it is not clear when this might occur.

An important part of any such evaluation will be looking at the number of interval cancers — these are the cancers occurring between screening rounds after a participant has returned an initial negative test.

Screening is complex.

It deserves better decision-making than politicians’ knee-jerk reactions to court voters in a television debate.

If any leader needs tips on how not to become a gullible grandmother on the campaign trail, I am here to help.

 - Elspeth Mclean is a Dunedin writer.