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There's a belief that bowel cancer is an old person's disease – it's wrong

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Bowel cancer is one of our biggest killers, but you’re mistaken if you think it’s just a disease of the elderly.

Randal McAlister was in his late forties when he started experiencing one of the main symptoms of bowel cancer – rectal bleeding. The Aucklander saw a GP, who thought he had haemorrhoids, so didn’t send him for tests.

“There was a long time where we ignored the symptoms,” says McAlister’s partner, Kelly Banks. “It’s so easy to put your head in the sand.”

The couple told themselves everything was fine, but after two years, as the bleeding got worse, sought a second opinion. This time, McAlister was sent for a colonoscopy.

“He had a 5cm tumour that doctors said had been growing for years and it had spread to his liver,” says Banks.

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To battle his stage 4 cancer, McAlister has had five operations, chemotherapy and radiotherapy. The couple will always wonder whether an earlier diagnosis would have meant he needed less-aggressive treatment.

A free national bowel cancer screening programme is being rolled out. Although this is positive, there are concerns that it may make getting a diagnosis harder for some patients, including those, like McAlister, who fall outside the screening age range of 60 to 74.

The New Zealand Society of Gastroenterology recently released a report showing that the country doesn’t have enough specialists to perform colonoscopies. Some district health boards are critically under-resourced, and 42% of existing gastroenterologists are likely to retire in the next decade.

Medical student Zoe Windner. Photo/Supplied

New research by University of Otago medical student Zoe Windner suggests that those most at risk of delays in diagnosis are younger patients, Māori and Pasifika people and those with less formal education.

“Bowel Cancer NZ was concerned about anecdotal stories about delays,” says Professor Sarah Derrett, a supervisor of the research project. “We also knew from a large review of patient records that a very high proportion of people are being diagnosed acutely through emergency departments, much higher than in similar countries such as England and Australia, which means the diagnosis is coming at a much later, more advanced stage.”

An online questionnaire showed the time between symptoms being noticed and a diagnosis being made was often six months or more, with some patients needing to return to the GP several times or seek a second opinion. And GPs can struggle to get patients seen by a specialist.

Further work by another researcher shed more light on the challenges. One patient had been told not to worry about stomach pain, as they were too young for cancer. And a woman with a family history of bowel cancer was told by her GP not to be concerned as it ran in the male line. This couldn’t be further from the truth.

New Zealand has one of the highest rates of bowel cancer in the world. It kills as many women as breast cancer, as many men as prostate cancer and isn’t only an old people’s disease – about 300 New Zealanders under 50 are diagnosed each year.

Sarah Derrett. Photo/Supplied

To prevent more unnecessary deaths, Bowel Cancer NZ is calling for an increase in the number of specialists who can perform colonoscopies and is hoping that once the screening programme goes nationwide (it’s available in seven regions), the entry age can be lowered to bring us in line with other countries that start screening at 50.

In the meantime, it is possible to buy a faecal immunochemical testing kit from pharmacies. This uses the same technology as the Ministry of Health screening programme kit. Although some people have no symptoms, anyone who does should see their GP. Signs include rectal bleeding, a persistent change in bowel habits, abdominal pain (especially if it’s severe), unexplained weight loss, tiredness and any lumps or mass in the stomach.

If getting referred for a colonoscopy in the public system proves hard, and paying $2000 to $3000 to go to a private clinic is out of the question, Derrett says a CT colonography – an X-ray of the bowel – is more affordable, although unfortunately it’s still out of the reach of many New Zealanders.

McAlister has now been cancer-free for more than a year. For his partner, his illness has been life-changing in more ways than one. She has walked away from a corporate career and, with a friend, set up Support Crew, a free online platform to help people organise meals and practical help for anyone going through tough times, such as serious illness.

“I realised how short life is and how it can change in an instant,” says Banks. “It changed my mindset, and not only gave me the idea for Support Crew, but also the balls to do it.”

This article was first published in the February 9, 2019 issue of the New Zealand Listener.