Bowel cancer fears ‘contributing’ to low rates for screening

A fear that bowel cancer is harder to treat than other cancers may contribute to lower rates of participation in screening for the disease, new research suggests.

Uptake of screening for bowel cancer is 59 per cent among women aged 50 and over, compared to 77 per cent for cervical and 72 per cent for breast cancer in Scotland, the University of Glasgow study found.

They interviewed 59 women aged 51-64 who are eligible for all three screening programmes to examine reasons for the lower uptake of bowel cancer screening.

Some of those questioned felt they would notice if they had symptoms of bowel cancer and therefore thought they had less need of screening than for other types of cancer.

Participants who had not been for bowel screening said they feared treatment for it is more severe than for breast or cervical cancer and they would rather not know they had it.

One person interviewed said: “Sometimes I think I’d rather just not know and die, rather than be diagnosed with that and having a colostomy.”

Dr Katie Robb, of the University of Glasgow, said: “What we thought was very interesting was that bowel cancer treatment was perceived as being more severe than breast or cervical, one woman was saying you can live without your breasts or have a hysterectomy but you wouldn’t want to live with a colostomy bag. There was that idea that the treatment for bowel cancer is more severe than other cancers and they don’t want to find out because they think the consequences of being diagnosed are so bad compared to breast cancer. There’s much wider recognition that breast cancer can be treated and you can survive it but the public perception of bowel cancer is not quite there yet.”

She added: “We know that screening can save lives because it detects it at an earlier more treatable stage. Often people don’t appreciate that screening is for people who are asymptomatic so it can be detected at the earliest stages. Waiting for symptoms means it’s probably at a more advanced stage so it’s more difficult to treat.”

Other people interviewed said they were worried about not doing the at-home test correctly, some felt disgust about doing it while some said it was easier to delay or forget about it compared to breast or cervical screening which involve going to an appointment. In Scotland, since 2007, people aged 50-74 have been sent a self-complete faecal occult blood test every two years as part of the Scottish Bowel Screening Programme. To complete the test they have to collect two samples from each of three separate bowel motions and mail their completed kit for processing. Women in Scotland are also invited to attend a pre-arranged appointment for breast screening and to make an appointment for cervical screening, with all three tests offered free on the NHS.

For the study, led by the University of Glasgow, researchers identified and interviewed women in Glasgow with different screening histories from different socioeconomic groups, some who took part in all three screening programmes, some who took part in just breast and cervical screening and some who did not participate in any.

The research, published in BMJ Quality & Safety, recommends steps that could be taken to increase participation in screening, such as working to reduce fear around bowel cancer treatments and increasing awareness.