Debate stirs over bowel cancer screening in NZ


A specialist in public health medicine has slammed the Ministry of Health for not doing more to protect Kiwis against bowel cancer -- but an awareness organisation says that's "nothing but a distraction" from the larger issue of a lack of a national screening programme.

Around 3000 Kiwis are diagnosed with the cancer each year, of which around 1200 die. It's a devastating statistic that means New Zealand has one of the highest rates of the disease in the developed world.

There is currently a medical trial localised to Waitemata District Health Board (DHB) using faecal occult blood testing, in which a person takes a sample of their faeces in their own home and sends it away for testing via mail. In two weeks those Kiwis can hear if they have bowel cancer or not.

But Professor Brian Cox from the University of Otago says this system is redundant, particularly compared to his proposed alternative: flexible sigmoidoscopy.

Not too dissimilar from a colonoscopy, flexible sigmoidoscopy uses a tube to enter a patient through the anus and look into the last third of the large bowel. Two-thirds of bowel cancer can be found there, Prof Cox says.

It's a one-off procedure costing around $300 that a person can take after turning 60. Typically it takes 15 to 20 minutes, and Professor Cox says it increases a person's chance of survival by 43 percent.

Not only that, he says, but because it can detect pre-cancerous areas a flexible sigmoidoscopy can also prevent bowel cancer from occurring by 33 percent.

"It certainly reduces the incidence of the disease where testing the blood in your poos is designed to check for disease that is present, rather than prevent anything," he says.

Prof Cox says the Ministry of Health is reluctant to look at flexible sigmoidoscopy because it is reliant on research conducted in 2010 and it has put itself in a tunnel.

But Mary Bradley from Bowel Cancer New Zealand (BCNZ) says the entire debate over which screening method to use is "nothing but a distraction from the pressing need for a national screening programme".

She says the fact that the sigmoidoscopy only checks one-third of the bowel is "a major concern" and says having spoken with the BCNZ's medical advisory panel, they are of the belief that faecal testing is more effective.

"[The faecal test] has been proven to work [and] there's a lot of evidence saying that it's cost-effective as well," she says.

"Introducing the sigmoidoscopy is just a distraction. We really need to focus on what is working, and they've been trialling this for four years now in the Waitemata pilot and it has proven itself.

"Rather than delaying, we need to get a screening programme in place now -- not be assessing other screenings when the one that we currently have works."

Newshub tried to contact the Ministry of Health yesterday as to why flexible sigmoidoscopies aren't being used, but they declined to comment until Monday.

Prof Cox says it's because the government agency has been "dragging its feet" trying to get up to speed on modern bowel screening.

"It's not taking flexible sigmoidoscopy seriously in the slightest because they've had six years to actually tackle this issue."

However Ms Bradley, who is a bowel cancer survivor herself, says alternative screening shouldn't be at the top of the Ministry of Health's agenda. She says it's a conversation which should only be had after the rollout of a national screening programme.

"Only one DHB [out of 20] has been able to take up the screening," she said. "It's been really effective [and] it's got a good take-up in terms of people doing the screening when it's offered to them, so it really needs to be rolled out nationwide."

Of the sigmoidoscopy's ability to detect pre-cancerous polyps, Ms Bradley says it's "interesting", but she maintains that screening method still pales in comparison to a colonoscopy, which screens the entire colon.

New Zealand's bowel cancer rates and cancer death rates are the worst in the developed world, and Ms Bradley describes the lack of a screening programme throughout the country as "really frightening".

"From our point of view the pilot has proven itself, it's been going for four years, it saves lives," she says. "Recent statistics showed that the pilot picked up 260 cancers, so we don't know why the Government's stalling.

"Last year [Health Minister Jonathan] Coleman said he'd be taking a case to the Government to get the screening started, but we haven't heard anything back on that.

"Twelve-hundred people are dying a year while we wait."

Despite Ms Bradley's sentiments, the flexible sigmoidoscopy is increasingly popular worldwide; family physicians in the United States have been trialling the screening at some of the country's bigger practices, while some doctors in the UK are also trying to push the screening method through.

Prof Cox says the international examples should be enough for the Ministry of Health to realise it is wasting time with other forms of bowel screening.

But Ms Bradley says the only waste of time is the discussion on whether the sigmoidoscopy method is best, and she worries it will just mean further delays to the rollout of a nationwide screening programme.

"This should have been discussed nine years ago when they were looking at workforce issues around screening," she says. "It's just far too late. We're one of the only OECD countries that doesn't have a national screening programme in place.

"This is just a distraction, and it's a distraction New Zealand doesn't need."