What to expect during bowel cancer screening

Speaker 1 Dr Zoe Williams, TV Medical Presenter and NHS GP: In this country, we do have screening available for bowel cancer, which is really good news because that is another tool to help us identify changes early on. Can you tell us a little bit about the screening?

Speaker 2 Mr Shahnawaz Rasheed, Consultant Colorecta Surgeon, Bupa: The screening is normally every two years for everyone in this country from the age of 60 onwards. Many people are offered it at 56 as well in most areas and you have it every two years. And what that does, it's not a test for cancer, but it's a test for the presence of blood in your poo.

That's an important thing to recognise because even if it comes back positive, the vast majority of people with a positive test doesn't mean they've got cancer. It just means there's blood in the poo. Now remember, the commonest cause for blood in the pool isn't cancer – it’s haemorrhoids and other things in the bottom.

So although people might think oh I've just got haemorrhoids, with bleeding, you might be right. But you want to be sure and you want to make sure that there's nothing else worse than that and so that's why we encourage the test to happen.

Now the new test, something called a FIT, which stands for Faecal Immunochemical Test is a really accurate way of picking up the presence of microscopic blood in the poo. So remember when we're looking at the poo, sometimes you don't see it looks normal, you know, some people look at their poo more than others as we know.

But people generally might not see anything, but the test will pick it up at a very sensitive level. If it comes above a certain level and we that number is 10 above 10, then we would want to investigate with something like a colonoscopy or something like that

Dr Zoe Williams: And I wonder what your thoughts are as a GP, I sometimes will ask patients about their poo. Particularly, you know, have you had a change of bowel habit? Have you noticed any blood in your stool?

And often patients will say, well I don't look at my poo and almost seem quite embarrassed. We need to change that, don't we? Because we need to look at our poo.

Mr Shahnawaz Rasheed: I mean generally people are quite embarrassed to talk about these things aren't there. I mean who wants to talk about their toilet habits? Nobody does really, and so I think to raise that awareness is really important.

And particularly in younger people, I must say, something like 6 per cent of people with colorectal cancer are under the age of 50. So I think raising that awareness in all generations is really, really important.

People justify the symptoms to themselves. They say, oh it's this, it's that or hey it's something funny and all sorts of things that you've heard hundreds of times before thousands of times before, as I have, that you're just you justify it, because you don't want it to be those things.

So you make up something, oh it's because I had something funny to eat, or I've got piles, or you say all these things, but actually having that awareness to say you know what, I can't look at somebody and say you've got bowel cancer, you know, none of us can.

So what we have to do is say, well, there's an index of suspicion you might have it you might not, but it's definitely worth investigating and finding out whether you do or not.

Dr Zoe Williams: And the really important reason why is well, if it's not bowel cancer, that's reassuring, you don't have to worry about it anymore. But if it is, finding it early means the chances of curing it essentially, are so much higher than if you know, you leave it for months to get worse.

Mr Shahnawaz Rasheed: Definitely. Explain to people, it's not that bad, the whole process of diagnosis of coming to the answer. People are very scared of being examined or having tests that might be they might perceive to be difficult, or painful.

But if we can, I suppose make them feel more at home with us as clinicians and don't feel we break down those barriers between us. I think that's really important, generally not just for bowel cancer but across the board.

Dr Zoe Williams: I agree, coming back to screening. I've actually got one of the little tests here. I thought it might be quite nice to demonstrate just how easy this is to do.

So these if you're eligible for screening, and then people receive one of these in the post, and it's so simple.

All you do is when you've had poo in the toilet before you flush the toilet, take out this little stick. And the end of it you just get a little bit of poo on the end of it, put it in there, flush the loo, put it in an envelope, send it off. And that's a screening test done.

But it surprises me, I'm looking at statistics here. It says just over half of people, and 58 per cent in England and 56 per cent in Wales, who received the screening test, complete it.

I look at that number. I think that's very low.

Mr Shahnawaz Rasheed: Remember people if they haven't got symptoms they'll think that's not for me, I'm alright. Thank you. It's any when people have symptoms, they start seeking medical advice.

You're talking about people who are asymptomatic on the whole aren't you. So people who might have blood on their poo without realising it.

But they've got no change of their bowel habit. They've got no pain, their alright. So what most people think is if it ain't broke, don't try and fix me, I'm alright thank you.

Dr Zoe Williams: I think that's an important distinction to make isn't it? Screening tests like this are designed for people who don't have symptoms to try and pick up in this case, any blood in the poo.

At such an early stage before it's even given symptoms. So if people do have symptoms, don't hang around waiting for this, go and see a doctor straightaway. This is not the test.

Mr Shahnawaz Rasheed: Exactly so if you have bleeding and you’ve seen it. That trumps this, because you’ve actually seen blood.