September 19, 2022
Bowel Cancer New Zealand is calling for a clear plan from Te Whatu Ora Health New Zealand to fix worrying delays facing younger patients in accessing much-needed diagnostic screening – delays made worse by the COVID-19 pandemic.
In launching its Never Too Young campaign for the fifth year, Bowel Cancer New Zealand (NZ) says a lack of sufficient resources for diagnostic endoscopy is causing public waiting lists in some parts of the motu to spiral, placing extra stress on GPs seeking to refer patients with bowel cancer symptoms.
Bowel Cancer NZ Medical Advisor Professor Frank Frizelle says the burden of COVID-19 on the health system has not just discouraged patients with symptoms from wanting to bother their busy GP and risk possibly catching the virus, but has exacerbated already over-long public waiting lists for investigative colonoscopies, seen operating lists cancelled and put pressure on theatre and staff capacity – at a time when bowel cancer is rising in younger patients at a concerning rate.
“GPs and health professionals need to be able to refer patients with worrying symptoms no matter how young, and have the confidence they’ll get timely access to specialist assessment and appropriate investigation in a timely manner. Right now, that’s not the case, with many patients facing unacceptable delays due to waiting time deferments and a lack of resource, exacerbated by staff shortages and sickness secondary to the impact of COVID-19. Right now, many GPs have valid concerns that younger patients they refer for public hospital investigation will be denied assessment due to their youth and perceived lower risk. We are asking Te Whatu Ora to prioritise improvements to colonoscopy resource and capacity nationwide without further delay.
“We know that bowel cancer is increasingly prevalent in younger people in New Zealand. Research shows colon cancer has risen by 14 per cent in men and rectal cancer by 18 per cent in men under 50 alone in the past decade. In the next decade, it’s estimated that one in ten colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50.”
More than 3000 New Zealanders are diagnosed with bowel cancer, and 1200 die from the disease each year – 350 of those diagnosed are aged under 50.
Bowel Cancer NZ General Manager Rebekah Heal says the charity welcomes government plans to lower the bowel cancer screening age from 60 to 50 for Māori patients in an effort to improve earlier detection of the disease. However, Bowel Cancer NZ would like to see the lower age policy extended to include all New Zealanders from 45* onwards.
“We know that 22 per cent of bowel cancers in Māori patients are picked up when they are aged in their fifties, so it’s vital the move to lower the screening age is prioritised for them. However, 12 per cent of all bowel cancers diagnosed in Aotearoa New Zealand every year are in those aged 50 to 59, making this decision vital for hundreds of patients and their whānau. We mustn’t forget that Aotearoa New Zealand has a high rate of bowel cancer, costing as many lives as breast and prostate cancers combined.”
Auckland’s Anna Heritage-Sao says she was “dumbfounded” when told she had bowel cancer at age 32, two years ago. The HR professional says she ended up in ED after experiencing excruciating back pain, discharged with a diagnosis of a possible kidney stone. Her GP then referred her for a CT scan.
“I went into the scan relatively relaxed. But an hour later, I got a call from my GP practice saying my doctor wanted to see me urgently. A week later, I had an urgent colonoscopy and could tell immediately from the surgeon’s reaction that something was wrong. He asked for my husband to come up. We were told I had a tumour in my bowel and he was ninety-nine per cent sure it was cancerous.
“I was in shock really. I mean, cancer … at 32 .. really? I couldn’t get my head around it, as I didn’t feel sick at all, but of course, that’s the thing with bowel cancer, it’s called ‘the silent killer’ for that very reason.”
Anna had surgery to remove the 6 centimetre tumour and is now cancer-free. She’s a passionate advocate for Pasifika health and for encouraging adults of all ages to get any worrying symptoms checked out immediately. She says she’s had friends and family visit their GP with bowel cancer symptoms yet be told they don’t need further investigation due to the fact they’re too young to likely have it. One friend, she says, was referred by her GP for a public hospital colonoscopy but declined, due to her youth and perceived low risk.
Bowel Cancer NZ says it’s Never Too Young campaign stresses the importance of not just health professionals considering a potential diagnosis of bowel cancer when seeing a younger patient, but for the patient themselves to be much more aware of the key signs and symptoms.
“Never Too Young drives home how vital it is for every New Zealand adult to know the symptoms of bowel cancer. These include bleeding from the bottom, a change of bowel habit, any lumps in the stomach, fatigue or tiredness, anaemia and unexplained weight loss,” says Rebekah Heal.
We urge all health professionals to consider referring patients for further investigative tests without delay, no matter their age, if they present with rectal bleeding, a change of bowel habit and stool consistency. With 90 per cent of bowel cancers treated successfully when picked up quickly, early detection is a lifesaver.”
* Journal of the National Cancer Institute, Volume 109, Issue 8, August 2017, djw322, Colorectal Cancer Incidence Patterns in the United States, 1974–2013 , https://doi.org/10.1093/jnci/djw322