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So when a letter popped through my door recently from the NHS asking if I wanted a bowel scope screening test I was intrigued- because I hadn’t heard of it before.
The test – which involves passing a thin flexible tube with a tiny camera on the end through your anus to look at the large bowel – is being offered once to everyone around their 55th birthday.
The leaflet that accompanies it explains it can find and remove small growths called polyps from the bowel. Polyps do not usually cause symptoms but some might turn into cancer. So the bowel scope screening test – also called a flexisig aims to remove them before they do.
Having the test involves an enema to make you have a poo before you go to the clinic. Carbon dioxide gas is pumped into your bowel to open it so the doctor can see inside with the camera. It takes around ten minutes and according to the booklet, Bowel Scope Screening, ‘most people are glad they had bowel scope screening done and find it painless.’ If you do feel pain though you can have gas and air (commonly used by pregnant women in labour.)
You can go home the same day, they say, and even drive yourself home.
However, there are risks with the screening. The leaflet warns one person in every 3,000 may have serious bleeding caused by bowel scope screening – rarely the bowel can also be torn or perforated. It doesn’t spell it out but both of these can be life threatening and would involve emergency surgery or a blood transfusion.
That said, bowel cancer is the third most common cancer in the UK with one in 18 people getting it in their lifetime and the risk increases with age. The NHS claims having bowel cancer screening helps prevent bowel cancer and ‘saves lives’ – for every 300 people screened it stops two from getting bowel cancer and saves one life from bowel cancer.
So given the above will you have a bowel scope screen?
My issue with the leaflet is there is not enough information to make an informed decision. To find out more and decide a bowel scope is not for me I have really had to dig around the internet.
Firstly I discovered a significant number of people, especially women, do feel severe pain. Currently there is a study going on to see if using water instead of gas would help.
Some people’s digestive systems are quite upset with the gas with bloating and cramping pains. You might not go to the loo normally for several days, you might get some bleeding when you get home and you might need to stick to light meals for a day or so.
If giving yourself an enema at home (one is sent in the post) doesn’t work as well as it should, you might need another at the clinic. If you feel pain the doctor might not be able to look at much of the bowel at all.
All of this isn’t mentioned in this leaflet – nor the fact you will have to sign consent for emergency treatment should you need it – or that bleeding and serious after effects can present in the next few days after you get home (not just at the time.)
There is also no mention of the risk of infection, always a consideration with any medical procedure.
But for me the main issue is there is no guarantee you won’t die from bowel cancer in the next few years. This is because a bowel scope screening doesn’t find every tumour and doesn’t go nearly deep enough into the bowel to find all lesions or polyps (for that you need a full blown colonoscopy). Unsurprisingly what the leaflet doesn’t say is that this test only reduces your risk of developing bowel cancer by a third. It has therefore been described by some medics as ‘only screening one breast’.
There is also no mention of over diagnosis of cancer. This is a big issue with breast cancer screening as the NHS admits for every one person who is treated for a real cancer, four women will be treated for a ‘cancer’ which never would have harmed them. This is because it is impossible for pathologists to know which tumours will progress and which will not – so all are treated (with either surgery or/and radiotherapy or/and chemo.)
Any polyps found during a bowel scope screen will be sent off for biopsy. It isn’t always clear which ones will progress to cancer. Of course any doctor must err on the side of caution and if they’re not sure they will suggest further investigations such as a colonoscopy or surgery. It is possible therefore you could be treated for a ‘cancer’ that you never would have known about and that would never have harmed you.
Having done all the research my decision is that I would need the chance of developing bowel cancer to be reduced much more than a third to justify the risk, however small, that I might end up damaging my bowel with screening. I am not alone – it seems take up of this very invasive procedure is only around 50 per cent at best.
There are also other tests – the Faecal occult blood test (FOBT) and the Faecal immunochemical test (FIT) which are less invasive as they test a sample of stool for blood. If any is found then you can undergo further tests.
Additionally I am mindful that in February 2015 my late father, Kingsley Squire, who had been suffering from tummy pains, had a full blown colonoscopy – and was given the all clear. However, nine months later he was dead from pancreatic cancer (which was never spotted until it was too late.)
Unfortunately there are so many cancers we can all get so, unless you have a genetic predisposition to bowel cancer, it seems madness to place so much focus on just one. I would rather the NHS spent money educating people to eat better and exercise more (two ways of preventing bowel cancer for nothing) – and also that people with symptoms are seen faster.
Meanwhile I can only presume the NHS hasn’t pushed for publicity and press about this new test because it is worried if bowel scope screening is analysed too much, it will put most people off.
Find out more: The NHS bowel scope screening programme
Read more about bowel scope screening: NHS Bowel Cancer Screening Programme leaflet
Have you decided to have a bowel scope test? If so, let people know of your experience below. And if you chose not to have it, tell us why…!