Bowel Cancer, or colorectal cancer as it is also known, is a broad term used to describe tumours that originate in any part of the bowel or rectum.
Approximately, 2200 cases of bowel cancer occur in Wales annually, with around 300 more cases diagnosed in men than women. Bowel cancer currently represents the fourth most common cancer in Wales – yet is the second leading cause of cancer death, with over 900 people dying each year from the disease.
While survival rates for bowel cancer have steadily increased over time, around half of all bowel cancers are still diagnosed at an advanced stage in Wales.
As with other types of cancer, bowel cancer when advanced, is harder to treat, manage and cure, than if caught earlier. Indeed, 5-year survival rates exceed 95% when diagnosed at the earliest stage, but drop dramatically to below 15% when diagnosed at the latest.
Of concern are the lower bowel cancer survival rates observed in areas of Wales that have the highest levels of deprivation, when compared to least deprived regions. Reasons for these inequalities are likely to be numerous, with each contributing to give rise to the overall reported trends.
These may include, amongst others, a higher frequency of known risk factors such as smoking, obesity, poor diet, excessive alcohol intake, low participation in national bowel cancer screening programmes, lack of awareness of symptoms, or fatalistic beliefs with people less likely to act on symptoms when they occur.
Bowel Cancer Symptoms
ICBP4, an international study involving over 2000 bowel cancer patients from 10 countries with similar healthcare systems showed the most common symptoms of bowel cancer in Wales to be blood in stools, a persistent change to normal bowel habits, and fatigue, followed closely by unexplained weight loss and abdominal pain.
Another factor besetting this complexity is recent research conducted by the Wales Cancer intelligence Service and supported by Macmillan.
This study showed that up to 1 in 4 cancer patients in poorer areas of Wales are more likely to suffer from at least one other serious long-term health condition, such as diabetes, dementia, muscular-skeletal disorders, or cardiovascular disease, compared to those in affluent regions.
The above study underlines the challenge GPs face when trying to diagnose cancers based on symptoms alone. Cancer symptoms are often multiple, vague and common to many other more prevalent and less serious conditions that exist in the population.
Worryingly, ICBP4 also established that patients in Wales take longer to visit their GP after first noticing symptoms than those in most other countries. Judi Rhys, CEO of Cancer Research Wales, which funded the Welsh component of the ICBP4 study, comments ‘It is very important that patients act quickly if they notice or suspect symptoms of bowel cancer, regardless of their age or other conditions they may have. Their GP will be well positioned to provide further support, advice, or reassurance’.
The Challenges of Bowel Cancer Diagnosis and Treatment
The most striking finding from ICBP4 was that patients in Wales have to wait, on average, over 5 months before they start treatment, with 1 in 10 facing delays of over one year.
These delays were appreciably longer than any other country involved in the study, including those in the U.K., and more than double that of some of the best performing countries in Europe.
Increased demand for services and limited access to diagnostic procedures such as endoscopy and pathology, following GP referral, are thought to be the major factors contributing to these delays.
Judi Rhys, added “This important study has enabled us to identify exactly where in the system the hold-ups preventing timely bowel cancer diagnosis and treatment occur. The evidence acquired will prove invaluable for building the new single cancer pathway that is being planned for Wales.”
The study clearly highlighted the need for greater investment in diagnostic capacity, both in terms of equipment and trained personnel. Easier access to routine investigations and more streamlined entries into the cancer pathway will allow patients to travel more seamlessly through the system, quickening both diagnosis and treatment.
Bowel cancer screening reduces the risk of dying from the disease, as it offers the best opportunity to detect cancer before symptoms occur.
While rates of screening uptake are on the rise in some parts of Wales, the lowest rates of uptake are consistently seen in the most deprived areas across all 7 Health Boards in Wales.
Latest statistics from Bowel Cancer Screening Wales, show uptake as low as 40%, in the poorest areas within Cardiff and Vale University Health Board – well below the 60% target set by Welsh Government.
Other concerns around the bowel cancer screening programmes in Wales, include capacity.
Presently, there are only 20 endoscopy specialist nurses and 18 registered screening colonoscopists – these are specialists trained in using thin tube-like of instruments with lights and lens attached for viewing inside the bowel – in the whole of Wales.
Issues of space in which to undertake these routine procedures also cause problems for some Health Boards. Pressures that will only increase when the age of bowel cancer screening is lowered to 50, and the newer more sensitive screening kits are rolled out more widely across Wales.
Stay tuned for our next blog which will be looking at way to reduce the risk of bowel cancer and the lifestyle changes you can make!
Blog Written by Dr Lee Campbell – SCIENCE PROJECTS AND RESEARCH COMMUNICATIONS MANAGER