Late diagnosis ups cancer risk

Nelson woman Angela Holbrook still feels lucky to be alive 15 years after a delayed bowel cancer diagnosis.

By the time she got a colonoscopy, 18 months after the first symptoms, doctors found a giant tumour blocking threequarters of her bowel.

Holbrook, 67, is one of many New Zealanders to receive a late diagnosis of bowel cancer, according to a recent University of Otago study.

Study author Zoe Windner investigated the experience of 98 bowel cancer patients to assess why it’s faster for some Kiwis than others.

She found late diagnoses were more likely for those receiving public healthcare, increasing the chances of a ‘‘poorer outlook’’ and potentially early death.

For 56 per cent of participants, it took six months or longer to be diagnosed, a situation more likely in the public system; and lesseducated people, those from poorer backgrounds and Ma¯ori were found to be most at risk.

For Holbrook, two fainting episodes, which if investigated could have revealed the tumours, were instead attributed to possible epilepsy by a neurologist.

But she decided she could not face taking the medication, with its significant side-effects, when there was no conclusive evidence of epilepsy.

A few months later she began getting regular digestive upsets, putting this down to stressful life events and a death in the family.

But when she saw blood in the toilet, Holbrook went back to her

family doctor. A referral to a bowel specialist followed and a colonoscopy was booked. Then aged 51, Holbrook was shocked when in 2003 she was finally told about the tumours in her bowel.

Her surgeon said she could wait two weeks for surgery to be done publicly – or she could get it done the next day if she went private. Holbrook opted to go private as she had health insurance.

But her health hell was far from over, as the cancer spread first to her liver and then to her lung.

Treatment for the secondary cancers was provided by the public system as Holbrook was unable to afford the top-up costs required by her insurance policy for a private provider.

In New Zealand, 24 per cent of bowel cancers were metastatic, or terminal, at diagnosis compared with 19 per cent in Australia and 17 per cent in Britain, the Otago University study said.

Delays in diagnosis of six months or more were most common for younger patients, Ma¯ ori, those without a tertiary qualification and those treated in the public system.

Most often patients were found to have consulted a friend or family member about worrying symptoms, then went to a GP and were referred to a specialist.

Access to timely diagnosis was likely related to socioeconomic status of individual patients, the study authors discovered.

‘‘Wealthier New Zealanders are able to afford to pay for private healthcare services out of pocket to hasten a diagnosis, and poorer New Zealanders do not have such access, leading to inequities.’’

The study sample included a higher number of younger patients (73 per cent were under 60) and therefore was not representative of all colorectal cancer patients in New Zealand, Windner, a medical student, said.

She called for more, larger studies to help improve understanding about diagnostic services for bowel cancer

‘‘. . . don’t let the first doctor you see put you off.’’ Angela Holbrook

patients. The Otago study showed more awareness was needed about the symptoms of bowel cancer.

Many participants did not visit healthcare providers during stages because they attributed symptoms to something benign, believed they would resolve themselves or they found them embarrassing.

Some symptoms did encourage patients to see a doctor, including a change in bowel habit, rectal bleeding, abdominal pain, unexplained weight loss, low energy and anaemia or iron deficiency.

A national bowel cancer screening programme for people aged 60 to 74 is being rolled out in New Zealand, with seven of 20 district health boards offering free assessments.

But Windner’s supervisor Professor Sarah Derrett warned this new programme might further limit diagnostic resources such as colonoscopy or CT colonography for people who do not meet the programme criteria, potentially increasing delays further.

Holbrook, meanwhile, said she had become a lot more vigilant about her and her family’s health.

Her two children have been encouraged to have regular colonoscopies and her daughter has already had pre-cancerous polyps removed as a result.

She advised people to take action if they had any symptoms. ‘‘Always go and push your own barrow. For a healthy person, with something that happens out of the blue, don’t let the first doctor you see put you off.’’