THE TWISTED TRUTH

Tra­di­tion­ally seen as an ‘old per­son’s dis­ease’, bowel cancer has set its beady eye on a new tar­get: peo­ple like you. Num­bers of young Bri­tish women be­ing di­ag­nosed with the con­di­tion are grow­ing – we’re ask­ing why

Women's Health (UK) - - CONTENTS - CHAR­LOTTE HUFF, words ALEX DAVIES EMMA PRITCHARD and

How bowel cancer be­came a real threat to young women

Let’s, even if only while you read the next four pages, cut the crap; none of this ‘num­ber two’ non­sense or the idea that the word ‘stool’ ceases to ex­ist out­side the con­fines of a GP surgery. Be­cause – for no other rea­son than that it could make an in­cred­i­ble dif­fer­ence to your health – it’s good to talk shit. When Ally Parry vis­ited her doc­tor with ma­jor fa­tigue, she wasn’t sur­prised to hear her iron lev­els were low – be­ing fe­male, a veg­e­tar­ian and a new mum all ticked boxes. But a se­ries of events, in­clud­ing in­con­sis­tent blood-test re­sults and per­se­ver­ance from both Ally and her doc­tor, led to a di­ag­no­sis that no­body saw com­ing. She was iron-de­fi­cient be­cause she had bowel cancer. She was 29 years old. ‘Hear­ing the news was har­row­ing,’ she re­calls. ‘I had a CT scan the next day to see if the cancer had spread to my liver and lungs. I was so re­lieved when they didn’t find any. I’ve never cried so hard – I’d be able to be a mother to my son.’ Be­fore the di­ag­no­sis that changed her life, Ally thought lit­tle of the C word. As for bowel cancer, she thought that was ‘an old man’s dis­ease’. The lat­est stats re­veal a dif­fer­ent re­al­ity: that the cancer (symp­toms of which can in­clude gas, a change in bowel habits, bleed­ing and, as in Ally’s case, anaemia) has started af­fect­ing women like you. Bowel cancer among women is on the rise – rates are 4% higher than they were 20 years ago, while cases among men have re­mained sta­ble. Right now, it’s the sec­ond most com­mon cancer to af­fect women world­wide, third in the UK, with around 50 women re­ceiv­ing a di­ag­no­sis ev­ery day.

CAUSE FOR CON­CERN

But the most wor­ry­ing as­pect of this whole sit­u­a­tion? Many of these cases are in the ad­vanced stages be­cause they’re ini­tially mis­di­ag­nosed or caught too late. ‘If it’s de­tected early, at stage one, 98% of peo­ple will sur­vive bowel cancer for five years or

more,’ says Wil­lie Hamil­ton, pro­fes­sor of pri­mary care di­ag­nos­tics at the Uni­ver­sity of Ex­eter Med­i­cal School, and med­i­cal ad­viser for char­i­ties Beat­ing Bowel Cancer and Bowel Cancer UK. ‘But the sad truth is that many younger peo­ple have a lower chance of sur­vival from bowel cancer be­cause they of­ten face a de­lay in their di­ag­no­sis. Three out of five peo­ple di­ag­nosed un­der the age of 50 will be at stages three or four, with a third of those in an emer­gency sit­u­a­tion.’ More on the cause of these de­lays later. As ex­perts work to iden­tify the causes of the un­wel­come in­crease in suf­fer­ers, an in­con­sis­tency in healthy habits looks to be the main cul­prit. So, you went large on the Papa John’s last night, then de­cided this morn­ing was more of a bath-than-shower sce­nario, leav­ing no time to make your sched­uled work­out class. And what? All fine – un­less your good in­ten­tions fail to come to fruition more of­ten than not. As work­loads and per­sonal stres­sors in­crease, it’s easy to lose track of how much you’re re­ally eat­ing and ex­er­cis­ing. And a pile-up of this be­hav­iour can clog your bowel. Hit-or-miss nutri­tion, for one, can rob your gut of the con­sis­tent fuel it needs to stay strong. Added ki­los also court trouble: up to 11% of cases of bowel cancer were linked to obe­sity in a ma­jor re­view by the IARC Hand­books Of Cancer Pre­ven­tion – an in­de­pen­dent cancer agency that’s part of the World Health Or­ga­ni­za­tion (WHO). ‘Most of my pa­tients don’t eat as well as they’d like be­cause they’re al­ways on the go and heav­ily pro­cessed con­ve­nience food is a wel­come so­lu­tion,’ says David Mcarthur, col­orec­tal sur­geon at Spire Park­way Hospi­tal in Soli­hull. ‘But diet, al­co­hol in­take and weight play a key role in de­ter­min­ing your bowel cancer risk.’ Ac­cord­ing to a 2015 re­view by the WHO, there may be a link be­tween red meat and bowel cancer – and an even stronger as­so­ci­a­tion if the meat is pro­cessed. The ad­vice from the IARC is to limit con­sump­tion of red meat, par­tic­u­larly the pro­cessed stuff, in or­der to lower your risk. ‘Sim­ply put, what­ever you put in your mouth spends time in the bowel,’ says Stephen Fen­wick, con­sul­tant hep­a­to­bil­iary sur­geon at Ain­tree Uni­ver­sity Hospi­tal. ‘So, if there is any car­cino­genic (read: cancer-caus­ing) el­e­ment in what you eat or drink, that will come into di­rect con­tact with the bowel.’ Think of it like putting smoke into your lungs and it sud­denly feels a whole lot more real.

PR IS­SUES

Di­ag­no­sis de­lays com­pound the prob­lem. Bowel cancer isn’t on the health radar of the av­er­age twenty- or thirty-some­thing woman. Aware­ness is low and awk­ward­ness high. ‘The symp­toms are po­ten­tially em­bar­rass­ing: rec­tal bleed­ing, dis­charge and di­ar­rhoea,’ says Mcarthur. ‘And be­cause bowel cancer is rarer in younger peo­ple – de­spite the rise in cases – it can eas­ily be missed by GPS.’ Plus, this cancer plays dirty; many of us strug­gle with gut is­sues – they’re more com­mon among women – and typ­i­cal symp­toms of bowel cancer can over­lap with more in­no­cent and treat­able con­di­tions. ‘Many of my young ad­vanced-dis­ease pa­tients had been com­plain­ing of symp­toms for more than two years – they’d been told they had haem­or­rhoids,’ says Mcarthur. Signs like ab­dom­i­nal pain and cramp­ing could be mis­at­tributed to ir­ri­ta­ble bowel syn­drome, so get­ting any di­ges­tive prob­lems di­ag­nosed and un­der con­trol could be life-sav­ing. Screen­ings are one way to take such spec­u­la­tion off the ta­ble. In the UK, this in­volves ei­ther a di­rect bowel cancer test – a thin tube with a cam­era at the end is used to look for and re­move any polyps in­side your bowel – or an at-home test­ing kit, which

AWARE­NESS IS LOW AND AWK­WARD­NESS HIGH

will flag any need for fur­ther tests. But you’ll only be in­vited to com­plete a test if you’re over the age of 60 (or over 50 in Scot­land). The ad­vice for any­one else with symp­toms or a fam­ily his­tory of the dis­ease is to speak to your GP, who will re­fer you for tests, such as a colonoscopy.

DON’T LET IT SLIDE

When it comes to pre­ven­tion, the stuff that works is the stuff you al­ready know. Don’t smoke and check your al­co­hol con­sump­tion, since drinkers are more vul­ner­a­ble to the dis­ease. As men­tioned, diet plays a ma­jor role, too – en­joy plenty of fi­bre-rich foods, such as legumes, whole grains and veg­eta­bles, to keep every­thing flow­ing as it should. Oh, and go easy on the ba­con, too. But there is also grow­ing ev­i­dence to sug­gest that gut health plays an im­por­tant role. ‘In­flam­ma­tion in the body can lead to an in­creased risk of de­vel­op­ing cancer,’ says Mcarthur. ‘A strong gut mi­cro­biome has been shown to re­duce in­flam­ma­tion, so there’s rea­son to think that it might also min­imise your risk of bowel cancer.’ Im­prove yours by eat­ing nat­u­ral cheer­lead­ers of gut bac­te­ria, such as ar­ti­chokes, ap­ples and sauer­kraut. And, as if you needed an ex­cuse, ex­er­cis­ing for just two and a half hours a week could slash your risk by 24%, ac­cord­ing to a study in the Bri­tish Jour­nal Of Cancer. The other sim­ple strat­egy? Be proac­tive: look out for any new, per­sis­tent be­low-the-belt aches. If your doc­tor de­liv­ers a rushed di­ag­no­sis – like it must be pe­riod-re­lated or it’s just stress – seek a sec­ond opin­ion. De­tail­ing ev­ery symp­tom, how­ever awk­ward, and in­sist­ing on tests could be a life­saver. ‘If you do have

per­sis­tent symp­toms, never be afraid to get them checked,’ adds Mcarthur. ‘Bowel cancer has one of the high­est sur­vival rates with treat­ment. If you’re not happy with your GP’S di­ag­no­sis, def­i­nitely push for a re­fer­ral.’ In­flam­ma­tory gas­troin­testi­nal dis­or­ders, such as ul­cer­a­tive col­i­tis or Crohn’s dis­ease, can also in­crease your odds. Ally im­plores women to trust their in­stincts. ‘It’s so im­por­tant to know and pay at­ten­tion to your body,’ she says. ‘It’s all too easy to put health symp­toms down to a crazy-busy life. I could have eas­ily dis­missed the low iron, but I knew that some­thing else was go­ing on, so I per­se­vered.’ Ally had a right hemi­colec­tomy to re­move the can­cer­ous part of her bowel and is now un­der­go­ing chemo­ther­apy. ‘I’ve been told my chance of sur­vival is about 85%,’ she says. ‘It’s clichéd, but it re­ally makes you stop and fo­cus on the present.’ The bot­tom line? In 90% of cases, bowel cancer can be treated suc­cess­fully. Symp­toms shouldn’t be cause for panic – blood in the toi­let bowl doesn’t au­to­mat­i­cally equate to bowel cancer. But it is cause for

‘NEVER BE AFRAID TO GET SYMP­TOMS CHECKED’

in­ves­ti­ga­tion and pos­si­bly a colonoscopy to rule out any­thing se­ri­ous. Peo­ple of any age with a fam­ily his­tory of bowel cancer, other risk fac­tors or symp­toms should al­ways get them­selves checked. If in doubt, talk it out with some­one you trust. It might be awk­ward, but it might just save your life.

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