From 1st July 2024, the national bowel cancer screening program lowered the age of eligible Australians from 50 to 45 years of age. Why is this significant? A/Prof David Read, colorectal, general and trauma surgeon from Melbourne Private Hospital explains.
Younger Australians, now from age 45 and up to 74 years, can access bowel cancer screening tests. Since the mid-1990s, there has been a steady rise in bowel cancer cases among younger individuals, with 11% of bowel cancers affecting people under 50 years old.1
“I think it is about time; we are seeing a larger number of people in their 40s and sometimes even their 30s that are getting bowel cancer, so the age that people have been afflicted by bowel cancer is getting younger,” says Associate Professor David Read.
The program aims to reduce deaths by detecting cases early, as over 90% can be successfully treated if caught early.2
“Bowel cancer screening has been shown to be very effective in saving lives, as bowel cancer is eminently treatable if you get it at an early stage. If you get it earlier, you are more likely to be cured, you are less likely to need chemotherapy; thus, if you are afflicted by bowel cancer, the earlier you are diagnosed, the better your journey and the better your outcomes,” states Associate Professor David Read.
A big challenge is that participation in the bowel cancer screening program among Australians remains limited, with recent data from 2021 showing that just over 40% of invited Australians participated in screening.3
What does a Bowel Cancer Screening test involve?
You will receive your kit in the mail with instructions on how to complete the screening, which you should follow carefully. What you should expect is to take a sample of your stool (poo) on two consecutive days and send it back using the pre-printed post pack provided alongside a completed participant details form.4
What are the main lifestyle factors that increase the risk of developing bowel cancer?
Your diet and lifestyle play a big role in your risk of developing bowel cancer. Making good choices can help lower your risk. Bowel Cancer Australia has identified the following factors as important ones to consider:5
- Diet
- Smoking status
- Alcohol intake
- Physical activity participation
- Prolonged use of aspirin
“There are many lifestyle factors that have been identified as possibly having a relationship with an increased risk of bowel cancer. These include not having enough fibre in the diet, limiting the amount of red meat to no more than one serve per day, or two serves four days per week. A serve is equivalent to two chops and two serves would be equivalent to a single steak. Unfortunately, eating regular amounts of processed and smoked meats such as salami, kranskys, bacon and prosciutto carries an even higher risk of bowel cancer, so such foods are a ‘sometimes food’, a treat rather than a regular food. In addition, risk may be increased by overindulging in alcohol or smoking any tobacco,” states Associate Professor Read.
“What you can’t change is if you have got a history of bowel cancer in the family. You may be at a higher than average risk and you may need to screen even earlier than 45 years old, or you may need to skip over faecal occult blood (poo) testing and have regular colonoscopies,” advised Associate Professor Read.
What are the symptoms of bowel cancer that indicate I should see my GP?
“Do not ignore any symptoms that you have in your bowel. So, if you have bleeding or a change in bowel habit, like unexplained constipation or diarrhoea that persists, do not ignore it. It may be that everything is okay, but it might not be, so get yourself in front of your GP and discuss your symptoms, and they are in a good position to decide if you need a referral to a surgeon or a gastroenterologist for consideration of a colonoscopy,” advises Associate Professor David Read.
Not everyone experiences symptoms in the early stages of bowel cancer, and many of the symptoms for bowel cancer may overlap with other conditions or side effects of some medications.
Common symptoms include:6
- A recent or persistent change in bowel habits, a change in the shape or appearance of poo, blood in the poo or rectal bleeding
- Frequent gas pain or cramps
- Unexplained anaemia
- A feeling that the bowel has not been emptied after going to the toilet
- Abdominal pain or swelling
“There are some symptoms that I say would need to persist for you to seek advice and there are some symptoms that need to be checked out all the time. For the latter, bleeding from the bowel will always need to be assessed,” advises Associate Professor Read.
Bowel Cancer Australia recommends that a person experiencing symptoms of bowel cancer for more than two weeks should make an appointment to see their GP.7
“We all occasionally get an episode of constipation or diarrhoea, but when it persists or is prolonged, then that is an indication that something might not be quite right, and a history of alternating between constipation and diarrhoea is something that most of us surgeons would want to know about and look into with a colonoscopy to make sure that everything is okay,” states Associate Professor David Read.
If I receive a positive result, who do I see and what are the next steps?
“The first thing to realise when you receive a positive result is statistically, you probably don’t have cancer, so don’t panic. I get many patients who think this is a test specifically for cancer, but it is a test for blood,” advises Associate Professor David Read.
A positive test indicates that a person should seek advice from their GP and gain a referral for further investigation within 30 days, according to Bowel Cancer Australia.8
“The test is designed primarily to detect polyps, which are precancerous growths. Of course, the test can also detect bowel cancer, but precancerous polyps are much more likely to set off a positive test. So, if you get a positive test, the government will send you a letter, you will go see your GP, and your GP will almost certainly go over what is going on, assess your general health, and arrange a referral for someone to perform a colonoscopy for you,” states Associate Professor David Read.
My GP recommended that I see a colorectal surgeon. What does a colorectal surgeon do and what further tests/procedures might they perform?
“A colorectal surgeon is someone who specialises in and has expertise in diseases of the large intestine or colon, rectum and anus. We deal with bowel cancer, diverticular disease, Crohn’s disease, plus problems around the anal region such as haemorrhoids, fissures and fistulas. If you test positive on a faecal occult blood test, a colorectal surgeon would almost invariably advise you have a colonoscopy test. This is a day surgical procedure under heavy sedation, where a camera examines the entire colon and rectum. If another cause apart from bowel cancer is identified, such as haemorrhoids, a colorectal surgeon is the right specialist to treat them at the same time as your colonoscopy,” says Associate Professor David Read.
What is the one piece of advice you would give Australians about bowel cancer and screening?
"I would strongly advise everyone over age 45 years old to do the bowel cancer screening test. It is very straightforward, not as gross as you imagine, and it could save your life. I have removed some very large polyps as a result of this programme that were likely only 1 or 2 years off turning cancerous," recommends Associate Professor David Read.
A/Prof David Read, Melbourne Private Hospital
Colorectal, general and trauma surgeon
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References
https://www.bowelcanceraustralia.org/what-is-bowel-cancer#diagnosis
https://www.bowelcanceraustralia.org/national-bowel-cancer-screening-program
https://www.bowelcanceraustralia.org/symptoms
https://www.bowelcanceraustralia.org/modifiable-risk-factors
https://www.bowelcanceraustralia.org/young-onset
https://www.health.gov.au/our-work/national-bowel-cancer-screening-program
https://ncci.canceraustralia.gov.au/screening/colorectal-screening-rates/colorectal-screening-rates
https://www1.racgp.org.au/newsgp/clinical/bowel-cancer-incidence-rates-up-266-among-15-24-ye
https://www.cancervic.org.au/cancer-information/statistics/bowel-cancer.html
https://www.canceraustralia.gov.au/cancer-types/bowel-cancer/statistics
