29 May 2019

New bowel cancer kit aimed to help those under 60

9:49 am on 29 May 2019

People under 60 who are worried they may have bowel cancer are being offered a new screening service by a group of medical specialists.

Samples of a colon biopsy to be sent to a laboratory, at Diaconesses Croix Saint-Simon Hospital, Paris, France (2009).

Samples of a colon biopsy to be sent to a laboratory. Photo: A. BENOIST / BSIP

Screening is publicly funded for those aged 60 to 74 under the National Bowel Screening Programme. It's being rolled out in stages but is so far operating in just eight of the 20 district health boards.

Bowel cancer is a major killer in this country. There are about 3000 new cases and 1200 deaths from it a year; 20 percent of cases occur in those under 60.

A new group known as bowel cancer screening has been set up involving 15 gastroenterologists around the country. Patients can take an online survey and answer questions about factors such as symptoms and whether there's a family history of bowel cancer.

Spokesperson for the service Alastair Patrick, who's a gastroenterologist at the MacMurray Institute and at Counties Manukau DHB, said if it's appropriate, based on that information, a kit costing $60 is sent to the person's home for a faecal immunochemical test (FIT) that detects early signs of bowel cancer.

The sample is sent back to a lab in Australia where it is analysed by a specialist gastroenterologist. If the result is positive, a recommendation is made from the screening service in this country for a further follow-up, depending on the participant's level of insurance cover.

Dr Patrick, who is also a leader of the national screening programme, said the two were complementary.

"There's no denying bowel cancer is an issue for New Zealand, and the current national screening programme is as effective as it can be on a limited national health budget," he said.

"At the same time, we're also seeing great early detection results in the likes of Australia, Scotland and Canada, where screening occurs from 50 years of age."

He added that more than 75 percent of bowel cancers are curable if detected early.

"So if you're not yet in the age or geographic range covered by New Zealand's testing regime, this test could save your life."

The test kit is similar to a kit sold for about $60 through some pharmacies, backed by Bowel Cancer New Zealand.

But, Dr Patrick said such tests should only be done on people who are well with no symptoms of bowel cancer and at only average risk of the cancer. Other more accurate tests were needed for others.

"So, the difference is the [bowel cancer screening] website targets the right test for the right person."

Dr Patrick rejected the view the new service could be a money-making venture for the gastroenterologists, saying that was unfair.

"People are entitled to be checked for bowel cancer. I think if the government is not providing it ... in certain areas currently [and] in ages that we think need it, then that's their right, I think, to have it and to pay for it if that's what they want."

Bowel Cancer New Zealand's spokesperson Mary Bradley said they supported the new initiative and hoped that people used the website as a way to assess their risk and need for either a screening kit or a colonoscopy.

"The question is what will happen when someone has a positive test and no private health insurance? Will their DHB accept the referral from their GP?," she said.

"We know that most DHBs have been rejecting positive test-kit referrals from GPs, which leaves people [who] can't afford a colonoscopy with no other options."

Dr Patrick said his group would write to a person's GP on their behalf, seeking a follow-up diagnostic colonoscopy if there was a positive result and they had no health insurance and couldn't afford a private colonoscopy.

"That's something that we would keep data on and if it is a significant problem then we would lobby the Ministry of Health about that. But other than the person having to pay for it out of pocket privately, there's not a lot that they can do, unfortunately."

The Health Ministry said anyone using a private kit, or private service, should not be doing so in the expectation that there would be a publicly funded colonoscopy provided.

It reiterated a warning given months ago, saying "users of a private bowel screening kit and analysis service are unlikely to receive publicly funded follow-up colonoscopy unless other clinically relevant factors are present".

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