Screening for bowel cancer reduces the risk of dying by 16 per cent, yet only 58 per cent of people who are eligible take part in screening. Here is a look at why customers should protect their bowel health and how the pharmacy team can help them

Every 15 minutes, someone in the UK is diagnosed with bowel cancer, with over 40,000 cases each year. It’s the fourth most common cancer after breast, lung and prostate, and the second most common cause of cancer death. “But over 90 per cent of cases can be treated successfully if caught in the initial stages, so early detection really does save lives,” says Mark Flannagan, chief executive of Beating Bowel Cancer UK. “This is why the role of pharmacy staff is fundamental in identifying patients who haven’t recognised that their symptoms might be cancer or are too embarrassed to visit their GP.”

The charity Bowel Cancer UK agrees, adding that the education of counter staff is equally important, as they are often a customer’s first contact in the pharmacy. And it’s important to have the knowledge and confidence to sensitively question the OTC medications that customers purchase. The lifetime risk for developing bowel cancer in the UK is now one in 14 for men and one in 19 for women. At the earliest stage of diagnosis (Dukes’ A) there is a 93.2 per cent five year survival rate, but only 6.6 per cent at stage D. Screening is an important way of picking up bowel cancer early, reducing the risk of dying by 16 per cent, says Bowel Cancer UK.

Low screening uptake

Despite the proven benefits of screening for bowel cancer, uptake in England is only 58 per cent, lagging behind other screening programmes such as breast cancer (72 per cent) and cervical cancer (79 per cent), says Beating Bowel Cancer. And new figures have revealed a 24 per cent difference between the highest and lowest areas for uptake across England, varying from 66 per cent in Dorset to just 42 per cent in West London.

“Taking part in screening is very important because it can find bowel cancers when they are small, before they cause symptoms. We know that those diagnosed under the bowel cancer screening programme are more likely to be diagnosed at an earlier stage and have better outcomes,” says Mark. “There may be a variety of reasons why people don’t take part in screening – bowel cancer being a taboo, the test that involves putting poo on a piece of cardboard and people not understanding that screening is a good thing. I think it’s important for pharmacy staff to be talking to customers in the age range for screening, asking them whether they have received a testing kit and whether they’ve taken part. We all have a role to play to make people more aware of the test and its importance. Pharmacy staff can help ease someone’s discomfort by talking to them in the consultation area and making them more aware of the symptoms to look out for.”

Bowel Cancer UK stresses that good knowledge of the screening programme and how to do the test is vital for all members of the pharmacy team, and liaising with local screening centres should be encouraged. Steve Riley, an independent clinical pharmacist, advises: “On an individual basis it’s important we take advantage of the fact that most patients will come to a pharmacy for advice and OTC products as a first line, in preference to seeing a GP. This can be due to embarrassment or not wanting to bother the GP. It’s important to highlight warning signs and promote screening.”

The screening test

The NHS bowel cancer screening programme in England began in 2006 and currently screens all men and women aged 60 to 74 every two years. In Scotland, bowel screening includes men and women aged 50 to 74 years every two years. In Wales, it’s for 60 to 69-year-olds and in Northern Ireland, it’s for 60 to 71-year-olds.

The current test used is the FOB (Faecal Occult Blood) test, which looks for blood in faeces. A new, more effective test called FIT (Faecal Immunochemical Test) is being piloted. The new test is more sensitive and only requires one stool sample rather than three, which should increase uptake.

The bowel scope screening test (flexible sigmoidoscopy) is a one-off test being offered to men and women aged 55. It uses a camera to check for abnormalities in the lower bowel, removing any polyps detected that could lead to cancer. “The benefit of the bowel scope is that it prevents bowel cancer from developing. It examines the part of the bowel where most cancers are identified,” says Julietta Patnick, Public Health England director of NHS Screening Programmes. Once the programme is fully rolled out, it could save up to 3,000 lives a year and prevent a third of bowel cancers in those screened. Currently, 37 per cent of scope screening centres are operational, with full roll-out planned by 2016.

Every 15 minutes, someone in the UK is diagnosed with bowel cancer, with over 40,000 cases each year

High risk groups

Bowel Cancer UK is calling for greater surveillance screening for people at high risk of bowel cancer. Genetic factors contribute to up to 30 per cent of cases and people in these high risk groups are likely to develop cancer at a much younger age. Crohn’s and ulcerative colitis can also double the risk if the condition has been active for a long time.

These groups should be in a surveillance screening programme, which is proven to reduce deaths. Recent evidence found that over half of centres don’t have a programme for managing high risk groups and only a third of centres identify and manage high-risk patients through a registry. The charity is calling for clear information for GPs and the public on who may be at higher risk of bowel cancer.

Surveillance screening has an 81 per cent reduction in mortality for moderate risk groups and 72 per cent for families with Lynch syndrome (a genetic condition that increases risk to 80 per cent).

What are the risk factors?

• Age: around 95 per cent of cases occur in people over 50 years of age, with 73 per cent of affected people aged 65 and over

• Family history: around 20 to 30 per cent of cases can be attributed to family history, with the risk increasing if the person has one close relative under 50 years of age when diagnosed or two relatives aged 60 and over.
• Around five per cent of cases are due to genetic conditions such as familial adenomatous polyposis (FAP) and Lynch syndrome. Crohn’s and ulcerative colitis can also double the risk

• Diet and lifestyle: a diet high in red and/or processed meat, and low in fibre increases the risk. New research found that a third of people carry a gene that predisposes them to an increased risk of bowel cancer if they eat processed meat. Alcohol, smoking, obesity and lack of exercise increase the risk too.

Know the symptoms

“We are dealing with one of the last taboos – bowel cancer and talking about bowels, bottoms and poo. While talking about these issues can cause awkwardness, we know that people are dying of embarrassment by delaying talking to their GP about their symptoms,” says Mark. Here are the signs your customers should watch out for:

• Bleeding from the bottom and/or blood in poo
• Change in bowel habits lasting three weeks or more
• Unexplained weight loss
• Extreme tiredness for no reason
• Pain or lump in tummy

 

Men are more at risk

Men are at higher risk of bowel cancer, with incidence rates up by 30 per cent during the last 35 years, compared with a six per cent increase for women. Men are less likely to recognise symptoms, see their GP or return a screening kit, says Bowel Cancer UK. It’s the third commonest cancer in men, accounting for 10 per cent of male cancer deaths. Yet participation for men in screening is consistently lower than for women, and men visit their GP 20 per cent less frequently. In addition, a study by SAGA found that just 55 per cent of men aged 50 and over were aware of the symptoms of bowel cancer compared with 72 per cent of women.

Healthy bowel advice

Some 57 per cent of cases in men and 52 per cent in women are linked with lifestyle and environmental factors. Here’s how to cut that risk:

• Eat less red/processed meat. The World Cancer Research Fund report suggests an increased risk of bowel cancer with high consumption of red or processed meat. The recommended limit is 500g red meat per week (max 80g per day), while processed meat should be an occasional treat only
• Increase fibre intake ideally to 18g per day. Fibre reduces time that waste stays in the gut and encourages the growth of beneficial bacteria. Good sources include granary bread, muesli, whole wheat pasta, brown rice, potatoes in skins
• Drink more water. Dehydration causes constipation and increases the time that waste spends in the bowel
• Take regular exercise – it can reduce the risk by 12 per cent. Losing weight can cut the risk by seven per cent
• Cut down on alcohol and stop smoking. Alcohol is linked with 11 per cent of cases, while the risk in smokers is around 20 per cent higher.

A high fibre diet with plenty of fruit and vegetables can help keep the bowel healthy

 

Signposting

• Bowel Cancer UK
• Beating Bowel Cancer / 08450 719301 / nurse@beatingbowelcancer.org
• CORE
• Information on constipation
• Information on bowel cancer screening
• Customers can read more about what screening involves by downloading the bowel cancer screening fact sheet
• To encourage customers to have conversations about bowel cancer symptoms, visit the Lift the Lid website