Falling Behind in the Behind, What Kiwi Men Need to Know

Catching up with preventing, rather than treating, bowel cancer
As we all know, Kiwi men just don’t get sick. Really, talk to anyone and they’ll tell you the same. Never need to go to the doctor. Waste of time and money. What do doctors know anyway? After all, “she’ll be right mate”.

What a shock to absolutely no-one else then, when it turns out that doctors do indeed know a thing or two. In particular they know a thing or two about New Zealand’s most diagnosed cancer. The one we don’t like to talk about (if we like to talk about any of them).

We don’t really want to hear that in fact bowel cancer is New Zealand’s second largest cancer killer. And we definitely don’t want to hear that men are not only more likely to develop bowel cancer now than women, they are likely to do so at a younger age.

So perhaps it is time to talk about bowel cancer after all. Perhaps, as with other parts of our mental and physical health, “she’ll be right” simply won’t cut it any more.

M2 spoke to Georgina Mason, CEO and Founder of the Bowel Cancer Foundation Trust. Georgina knows all too well what it’s like to try and convince a man to try and be pro-active about his health.

“I literally had to win a bet with my husband to make him take a bowel screening test I picked up from the chemist when he turned 50. I thought, if I can’t make him do it, I’ve got no hope of convincing anyone else”.

For reasons we don’t quite yet understand, Georgina says New Zealand has the highest rate of bowel cancer per capita, in the world. If that isn’t the kick up the backside Kiwi men need, then what is?

Clearly this is something men need to be made aware of. Especially as this is a disease that has the ability to be successfully cured – in 90% of cases – if it is found early enough. Ah, there’s the key right? How is it going to be diagnosed early enough?

Should everyone just always be on the lookout for symptoms?

Incidentally, those symptoms to look out for could include:

  • Blood in the stools and/or bleeding from the rectum
  • A change in bowel habit lasting longer than 6 weeks (e.g. loose stools, diarrhoea or constipation)
  • Stomach pain (often severe)
  • Lumps or a mass in the abdomen
  • Weight loss
  • Weakness and tiredness (symptoms of anaemia)

Well not necessarily. Of course if you do have any or all of the above symptoms you should be going to the doctor to be checked. However, the screening tests available for bowel cancer can pick up early warning signs for the disease as much as three years before any symptoms even present themselves.

Georgina said to us “Unfortunately I’ve spoken to a few patients who haven’t had any of those symptoms at all. Bowel cancer is often described as the silent killer as some patients can present with stage 4 bowel cancer and not even know they have it.”

In New Zealand, the government is currently in the process of rolling out a Free National Bowel Screening programme. This programme is only aimed at 60-74 year olds. However, there is an abundance of research to show that the screening age should be much lower. In Scotland, they offer screening from age 50. In America, it is currently 50 but the American Cancer Society want to start at 45. Many countries suggest it as a standard regular screening practice from age 50.

“I would advise anyone that is invited to take part in the free National Bowel Screening Programme to do so. It’s a great base to monitor your bowel health from and will give you peace of mind. If the test does detect anything, it’s better to deal with it straight away than leave it until it’s too late,” says Georgina.

There is an international recognition that the cost of screening, along with its effectiveness, would far outweigh the cost of treatment if the cancer were to be discovered at a later stage. In New Zealand, the Ministry of Health projected to spend $93 million annually on bowel and rectal cancer by 2020 (NZ Medical Journal). That’s an awful lot of money that could be put to better use if these cancers were caught and cured earlier.

So it seems that New Zealand may be lagging behind a little in recognition of this fact. Could it be a national “she’ll be right”?

The initial screening test is so simple it is available to buy at your local pharmacy, and really, perhaps you should? These tests are generally the first step and can detect minute traces of blood in the stool that can come from polyps before they turn cancerous in the bowel. Remove the polyps, remove the risk. It really is as simple as that.

Clearly your risk increases with age, but anyone over forty-five should potentially be undergoing regular screening tests. Yes, it’s all a bit nasty and we don’t want to think about it. But it’s an unpleasant two minutes out of your life every few years that may end up saving your life. Not exactly a difficult equation is it?

There are some factors that may increase your risk, so perhaps you want to review those before poking at your poo with a small stick. You may be at increased risk if any of the following apply to you:

  • Being older than 50 years
  • A diet high in red meat and animal fats and low in fruit and vegetable fibre
  • Lack of exercise
  • Smoking and Alcohol
  • A personal or family history of bowel cancer
  • Genetic factors associated with bowel cancer
  • Inflammatory bowel disease
  • Previous bowel cancer

If you’re still not convinced to give it a go, let’s look a little deeper (if you’ll pardon the pun) at what having bowel cancer really means.

Most bowel cancers start as benign innocent growths – called polyps – on the wall of the bowel. As mentioned above, the trace amounts of blood these polyps can leave in your stool is what the initial screening test can pick up. Polyps are like small spots or cherries on stalks and most do not produce symptoms. Polyps are common as we get older and most polyps are not pre-cancerous.

One type of polyp called an adenoma can become cancerous (malignant). If left undetected, the cancer cells will multiply to form a tumour in the bowel.

If untreated, the tumour can grow into the wall of the bowel or back passage.

Once cancer cells are in the wall, they can travel into the bloodstream or lymph nodes; from here the cancer cells can travel to other parts of the body. For bowel cancer, the most common places for bowel cancer cells to spread to are the liver and the lungs. The process of spread is called metastasis.

If you were to survive to this stage of course, those symptoms up above?

They would look like a picnic about now.

The types of treatment available naturally depend on what stage the cancer is at. If it is caught at an early stage, invasive surgery may not be necessary. Any later, and surgery is the go to option;

Surgery is performed to remove the segment of the large intestine, which contains the cancer. At the same time the surgeon removes 10 to 20 lymph glands, which lie close to the cancer in order to examine these under the microscope and determine whether the cancer has started to spread beyond the bowel.

If the cancer has spread, additional surgeries combined with chemotherapy are likely to be necessary. All of which sounds considerably more unpleasant than poking your stool with a stick.

Awareness is one of the main barriers to successfully catching and curing this type of cancer. Men tend not to discuss health issues among themselves. Which is a shame because other men are exactly who they would listen to the most. So many men have lost an uncle, a brother, a grandfather to this insidious disease. Yet they still don’t talk about it.

Awareness is the aim. Once we achieve that, the rest will follow. Perhaps if you conduct a screening test, and mention it to your brother, he may have one too. Worth a discussion to potentially save a life?

New Zealand may be falling behind in managing this disease, but New Zealanders are pretty good at catching up with the rest of the world.

In the worlds of science, sport and medicine we have not only caught up with, but on many occasions have in fact surpassed others. Dropping our overwhelmingly high rates of cancer would be a great way to do that once more.

So here’s to poking sticks at poo. It’s really not that bad. And honestly, once you pick up that stick, “she’ll be right”.