It has never been a remotely sexy or high-profile topic, but in election year bowel cancer has become the first health issue to trigger real debate.
Three thousand men and women are diagnosed with the cancer each year in New Zealand and 100 a month die from it. The death rate in New Zealand is one of the highest in the world, matching the combined death rates from prostate and breast cancer. In the spotlight are 50 to 70 year-olds, whose chance of surviving bowel cancer, if they have it, is much better if it is caught early.
So what are we doing? Well, many say not enough and not fast enough. For its part, the Government launched a $24 million pilot screening programme in Waitemata, Auckland, in 2012 but has steadfastly refused to commit to national screening until the end of the pilot next year.
That is despite the fact the pilot appears to be going well. At the 21-month mark more than 129 people had been found to have cancer, some more than one cancer, and some without any symptoms.
That has increased pressure on the Government, but it will not be hurried. Health Minister Tony Ryall said in late 2012 screening will be rolled out nationally, but only if workforce constraints can be resolved and if it stacks up clinically, which no-one expects to be a problem.
But most agree the workforce is a big problem. Those offered screening must be able to have a colonoscopy - where a tube containing a camera is inserted through the anus to look for abnormality in the bowel. There is already a waiting list for the procedures in parts of the country. Mr Ryall put in another $3.5m last week to help ease it.
Decisions are needed now on who will do the colonoscopies if screening is rolled out nationally. To find out a special, invitation-only, day-long symposium is being held in Wellington on 28 April, hosted by the Health Ministry. Up for discussion are topics including how to deliver colonoscopies differently, and the experience of nurse endoscopists, a group doing the work in Britain and beginning in Australia.
Some say New Zealand already has the workforce - or would have if doctors did less work in the private health sector and more in the public sector.
The Beat Bowel Cancer Aotearoa lobby is among those frustrated at having to wait. It and other cancer charities want the next Government to fast-track the programme. A Hamilton specialist has gone further, urging those 50-plus without symptoms be screened privately for their own health, at a cost of about $1800. He describes it as an attempt to "jump start" national screening.
The Labour Party last week pledged to roll out national screening within three years if it is elected in September. It would screen 50- to 64-year-olds beginning in Otago, Southland and Waikato. Waitemata would be the model and be permanent. Labour says it would prevent 180 deaths a year at an initial cost of $14m a year, rising to $60m to $70m under full national screening.
But any screening programme makes many in the health sector deeply nervous. The Auckland Women's Health Council says it would be "incredibly foolish and unethical to rush in to establishing yet another screening programme before we know precisely what resources are needed to screen, examine, diagnose and treat the healthy people that are being encouraged to undertake the screening test".
It is a debate the Government may have hoped to avoid this year, but that is no longer likely.