3 February 2011
Screening is an accepted part of medical life nowadays. Cervical screening, breast screening are certainly well-established.
It is worthwhile reminding ourselves what are the agreed criteria for a screening programme for a specific disease, namely:
a] It is an important one
b] The natural history of it should be understood
c] There should be an early latent or pre-symptomatic stage
d] There should be acceptable treatment for it
e] There should be an agreed policy on who to treat
f] There should be suitable tests or examinations
g] The facilities for diagnosis and treatment should be available
h] Tests and examinations should be acceptable to the patient
i] Case-finding should be a continual on-going process
j] The diagnosis and treatment should be economically reasonable
All of these apply to bowel screening which is now available nationally. One of our (elder) tutors was recently somewhat surprised to be asked for a second sample to test for occult blood and even more surprised to have an appointment made for a colonoscopy.
He was reminded (because he should have known already) that, of every ten colonoscopies, five are normal, four detect polyps which are removed during the procedure and only one detects bowel cancer. This is eminently treatable with a virtual 100% cure rate.
He found that the worst part of the process was drinking 4 litres (!) of supposedly vanilla-flavoured liqud to empty the bowl of its normal contents so that the colonoscopist (if there is such a word) could see what was going on. The colonoscopy itself was more uncomfortable than painful and, in our tutor’s case, led to no less than eight polyps being removed and sent off for histology.
The whole process was extremely efficiently organised. He was even rung up the following day to make sure he was alright.
But the thing that astonished our tutor the most was being told by his nurse that of all the people contacted for bowel screening only 50% take up the offer! Among the sillier excuses that is given is that, “if I’ve got something, I don’t want to know about it.” You’ll certainly know about it when the liver secondaries are developing from an untreated bowel cancer. People are strange. On the one hand, they get all excited about something as trivial as bird flu but, on the other hand, 30% of the population continue to engage in probably the most dangerous human activity (smoking) and 50% refuse to have a simple test to detect possibly the most successfully treatable of all cancers.
As we say in Yorkshire, “there’s nowt so queer as folk.”