Bowel screening needs hurry-up

The test is done at home and it’s simple. Adults collect a small stool sample using a test stick. After appropriate sanitation measures, the sample is posted to a lab for a faecal immunochemical test. This detects blood, which may be a sign that cancers are affecting the colon (large bowel) or rectum (back passage). Blood may also indicate pre-cancerous polyps – small growths that, left untreated, can turn into cancers. They can potentially spread to the liver, lungs and other places in the body.

About 75 per cent of bowel cancer is curable if caught early, according to Bowel Cancer NZ, a charity and advocacy group. And the earlier it is caught, the easier it is to treat.

As a result, New Zealand has been rolling out a National Bowel Screening Programme since 2017. Eligible people are sent free test sticks and packs every two years.

This programme is a good thing, but the rollout has been too slow and eligibility too limited.

Health Minister David Clark announced last week that a ninth district health board – Whanganui – had joined the programme. MidCentral DHB (Palmerston North, Manawatu¯ , O¯ taki) is expected to join next month.

This will mean 10 of 20 DHBs can offer the free test, but the biggest ones – such as Canterbury, Capital & Coast, Waikato, and Auckland – have not yet joined.

The ministry still insists all DHBs will provide the tests by June 2021, but these promises have been broken before. Canterbury, for example, was initially supposed to join the programme in 2017, then 2018, and now by June 30, 2020.

Blame for these sorts of delays can be shared between the ministry and DHBs.

The DHBs must pass ministry readiness assessments on facilities, staff and waiting lists before they can launch the screening programme. Some DHBs aren’t ready.

But funding from the ministry has not always been sufficient, according to Canterbury DHB officials, for example.

Even if all that could be solved tomorrow, there are eligibility problems. The programme is offered to men and women aged 60 to 74, but there is plentiful evidence that bowel risks start earlier and last longer. Australia’s screening programme starts at age 50 and the United Kingdom’s programme is moving to 50. The American Cancer Society guideline for colorectal cancer recommends that screening start at 45 and may be needed until 85.

Private citizens can buy a screening kit for $63.50 from some pharmacies or get one free from Bowel Screening NZ.

That’s significantly less than the $1900 to $2500 price tag of a private colonoscopy, which may be needed to remove polyps. Chemotherapy and surgery are more expensive still.

Screening is cheap. But it’s more than money. Bowel cancer is the second-highest cause of cancerrelated death in New Zealand, behind lung cancer.

More than 3000 New Zealanders are diagnosed every year and more than 1200 die. About one in 18 New Zealanders will develop bowel cancer in their lifetimes.

Since the programme began in 2017, about 180,000 people have been screened and nearly 400 cancers detected. Hundreds of polyps have been removed, according to Clark.

This is a proven programme that needs to be made available to more people more quickly. Get on with it.

. . . there is plentiful evidence that bowel risks start earlier and last longer.