To wonder why bowel screening starts at 50 in scotland

[Kaylasmum49]

Hi just wondering why bowel screening starts at 50 in Scotland but not until 60 in England. I just turned 50 so expect to receive my kit soon but was surprised to find out that it was started 10 years earlier here in Scotland.

Are we more at risk of bowel cancer here!?

[indyandlara]

On and off. I'm a lot better than I was in my 20s Over the years it's swung from IBS-C to IBS-D. I take anti spasmodically when I flare up. I also developed reflux so take Ranitidine daily. I avoid food triggers and try to exercise/ balance stress but that's easier said than done!

[MrsTerryPratchett]

Peppermint oil and low stress. That works for mine.

[indyandlara]

I'm a teacher with a DH who travels a lot for work. I've never managed to get the low stress thing right . Interestingly I'm always okay during very stressful situations but flare up in the aftermath when I'm starting to relax again. Peppermint capsules help me too.

[Kaylasmum49]

Sounds pretty much the same as mine. Stress is a huge factor.

[Doilooklikeatourist]

indyandlara I think I've had 5 or 6 colonoscopies over the last 15 years ( between 40 and 55 ) and I've paid for none of them
Mum died at 61 , and her mum had bowel cancer too , but in her 80s
Ask your GP again if screening would be a good idea for you

[indyandlara]

My GP thinks it should be done but the hospital say no and the protocol has changed. GP says she has never heard of this. It's all very frustrating.

[80sMum]

I am interested to read that some of you have been offered screening because a family member had bowel cancer.

My dad died of bowel cancer and I remember going to see my GP after dad died, to ask about my own risk. He said I probably was at 25% greater risk of developing bowel cancer than the general population. I was 39 when dad died.

I'm now 58 and have never been offered any screening.

[swissy56]

I think 55 is supposed to be the best age to have a colonoscopy. I will definitely push for one between 50 and 55. My DF died of bowel cancer and went with symptoms at 59 and it was quite advanced at that point. I will try to have one every few years after that if I can.

[jacks11]

OP, I think your healthy anxiety is preventing more rational consideration here- and I don't mean that unkindly. Googling is likely to fuel your anxieties and you need to be very careful about where you get your information from. I hope you are getting the help you need to deal with your anxiety.

I think you are unclear regarding specifics of screening. There are pros and cons to any screening programme (and any other investigation, medication or treatment for that matter). There are criteria to help guide whether a test is an appropriate screening tool or not- known as Wilson-Jungner criteria. I won't detail them here. No test is 100% accurate and will have false positive and false negatives- in the former leading to investigation of people without disease and in the latter missing a diagnosis in people with the disease. Decisions regarding when to start and end screening is based on when it most likely to be prevent the greatest burden of disease without leading to over investigation of people who are unlikely to have any disease. This focuses screening programmes in those age groups who are most likely to be affected.

There has to be a cut off point somewhere and that can mean, tragically, that people who could have been diagnosed earlier will not be- but realistically unless you screen everyone for everything from the minute they are born until they die, this is inevitable. In fact even if you did all the screening the false negatives would still mean some would be missed! And we don't have a screening test for everything anyway. However, the over-investigation could well lead to medical complications for many more people than is necessary or acceptable. And the cost would be astronomical, for very little gain in statistical terms.

And yes, cost-benefit analysis plays a role- it has to as the NHS cannot fund all things for all people. It has to use the money it has to best benefit the whole population. Not just people with cancer- after all cardiovascular disease, stroke and dementia are leading causes of death in the UK across all age groups ( exact breakdowns are different amongst different age groups).

More specifically, we are now using the FIT (faecal immunochemical test) which is more accurate that the previous test.

I would not support colonoscopy yearly for everyone over 50, incidentally. Colonoscopy is an invasive investigation which is not without risk. The burden on GI services would be crippling and would lead to money being diverted into this from other areas. That cannot be done lightly, and there would need to be evidence of a significant improvement in cancer detection AND reduction in mortality before it should be considered. It's not my area of expertise, but I don't think the evidence for this is conclusive. I'm not denying that using colonoscopy as screening may pick up people the FIT test would miss, and that this is tragic for those individuals, but you have to come to some sort of reasonable balance.

[lougle]

"I have read that 2% of people who do the fobt have positive result and that 6.7% of those people have bowel cancer. So I would say it definitely detects cancer."

You realise that it means that 0.134% of people who do the test have cancer detected as a result of the test, and 99.866% of people who do the test do not have cancer detected as a result of the test?

In fact, for 1 life to be saved from bowel cancer and 2 people to be prevented from getting it, 300 people have to be screened.

So whilst it's important, it isn't the only thing that impacts on cancer rates.

[missyB1]

Ok to clear up the benefit of the poo test, 1:10 positive FOBs will be cancer. But it's true that it's not a very sensitive test ( lots of false negatives and false positives),but it will be replaced by FIT test which is an immunochemical test which is much more sensitive (I believe this test is already what Scotland use), it's still a poo test.
A colonoscopy test for everyone would actually reduce the rate of bowel cancer because of polyp removal. However it would place far too much strain on Endoscopy units, it would require massive investment which with this Government is just not going to happen!! Those not fit for colonoscopy are usually weeded out by the bowel cancer screening specialist nurse (my last job). But yes all patients are consented for the risks of bleeding and perforation.

[Kaylasmum49]

If you're deemed not fit for colonoscopy what's the option?

[missyB1]

Kaylasmum: there is a test called CT colon which is a CT scan which concentrates on the bowel. It's good for patients who aren't fit for colonoscopy, the downside is it's not possible to remove polyps with this test.

[Kaylasmum49]

I have heard of that but it seems a waste of time if polyps are spotted and need removed.

[Kaylasmum49]

I read that 6.7% of positive fobts would be cancer, not 10%. This was from a reputable site

[joshlymanlover]

My dad had the screening but it didn't show up his bowel cancer. Luckily he went as soon as he had symptoms and was referred asap and this saved his life

[MrsTerryPratchett]

I read that 6.7% of positive fobts would be cancer, not 10%. This was from a reputable site Oh love, you do a lot of reading about this stuff, don't you? Have you had some useful support for the health anxiety and do you think you need more support?

[Kaylasmum49]

I've had cbt in the past which did help but I've had a great deal of stress in the last year which seems to have triggered my HA.

[Kaylasmum49]

I've heard that you can get a positive on a fobt due to other reasons, medicine, foods etc.

What worries me is that my gums bleed quite a lot when I brush my teeth, I would imagine that could influence the test?

[Kaylasmum49]

Sorry for the bump

[CrazyNameCrazyGuy]

Kaylasmum

Swallowing blood from your gums could possibly skew the result of a FOBT. It's something you'd need to discuss with your GP. For that matter, heavily bleeding gums are something you should be discussing with your Dentist!

"A positive FOB test will tell your doctor that you have bleeding occurring somewhere in your gastrointestinal tract. This blood loss could be due to ulcers, diverticulitis, bleeding polyps, inflammatory bowel disease, haemorrhoids (piles), from swallowed blood due to bleeding gums or nosebleeds, or it could be due to benign or malignant tumours."

labtestsonline.org.uk/understanding/analytes/fobt/tab/sample/

[Kaylasmum49]

Unfortunately along with my HA I am also dentist phobic! I tend to only go when I'm in agony. My gums don't bleed heavily but they do bleed occasionally so this concerns me.

Medical tests always send me into a bad downward spiral of severe anxiety and panic where just doing everyday things become almost impossible. So tired and down with all of this.

[Kaylasmum49]

Has anyone had a positive fobt and everything turn out ok?

I know I'm being a pain but my anxiety is pretty high today

[LunaLoveg00d]

Probably because Scotland as a nation has very poor health overall and there are large pockets of the country where people wouldn't know a carrot if it danced in front of them.

And from the NHS website:

"Bowel cancer (or colorectal cancer) is a major public health problem in Scotland, which has a higher rate of bowel cancer than most other countries in the Western world. In Scotland it is the third most commonly diagnosed cancer in both men and women with approximately 4,000 new cases diagnosed each year. Ninety-five percent of cases occur in people aged over 50 years. Over the last 10 years, bowel cancer incidence (2003-2013) in Scotland has decreased in men and increased in women, while bowel cancer mortality (2004-2014) in Scotland has fallen in both sexes. Bowel cancer is the second most common cause of cancer death for both men and women with around 1,600 people dying of the disease in Scotland each year."