The Sunshine Coast nurse and mother of two was diagnosed with bowel cancer in 2018 at just 38 years old.

“We are lucky that we live in a country where we have these tests available, so people really need to take part in screening, and listen to their body if something isn’t right.”

Ms Kriel was referred for a colonoscopy when she experienced stomach cramps and bloating.

“They removed two polyps from my bowel and pathology testing confirmed there was cancer present in one of them, it was so small a CT scan would have missed it. My surgeon said I am an ‘unlucky, lucky person’ because I was healthy and had no risk factors for bowel cancer, so I was lucky that the cancer was caught early.”

A study published in the May edition of The Lancet showed bowel cancer cases in people under 50 have risen in the last 10 years.¹

Pathology Awareness Australia ambassador, Dr Nick Musgrave is an anatomical pathologist who specialises in gastrointestinal pathology:

“With the data showing an increase in bowel cancer in younger Australians, anyone with symptoms should talk to their doctor. However, cancers can develop over several years and at the early stages may have few or no symptoms. That’s why it is important people take part in the screening program from the age of 50, to have the best chance of catching cancer early,” said Dr Musgrave.

Bowel cancer is Australia’s second biggest cancer killer, yet the 5-year survival rate for stage I bowel cancer is 99% and stage II is 89%.

For stage IV bowel cancer (metastatic cancer) the 5-year survival rate is just 13%.²

Ms Kriel’s cancer was at stage I and had not spread. She had surgery to remove half her bowel but was able to avoid radiation and chemotherapy after surgery.

“My bowel will never be the same, but chemotherapy is very gruelling and I was really worried about this when I was first diagnosed because it would mean prolonged illness and being away from my family. The psychological toll and financial burden of a cancer diagnosis and treatment is huge, especially for a younger person, you have your mortality thrown in your face.”

Despite this, a report released this month by the Australian Institute of Health and Welfare (AIHW) ² shows bowel cancer screening participation rates are worryingly low, just 41% in 2016-2017. And the participation rate was very poor (30%) in the younger age group, 50-54 years.

Dr Musgrave has called the numbers “astounding”.

“When you consider that bowel cancer in its early stages has a high survival rate but with late stage bowel cancer the survival rate is pretty dreadful, it is astounding that more people are not having the test. This is one of the cancers that we are able to screen for, so we must do everything we can to reduce the risk of having advanced disease,” said Dr Musgrave.

Under the National Bowel Cancer Screening Program, Australians aged 50-74 are sent testing kits in the mail to collect a faecal sample that is then posted to a pathology laboratory to be examined.

“I’ve turned 50 this year myself, and I know there’s an ‘ick’ factor with the test, but some people make too big a deal of having to sample their own faeces and may not realise that the test is actually pretty simple,” said Dr Musgrave.

“We know that participation rates for both cervical and breast cancer screening are much higher. The bowel cancer test is free of charge, is non-invasive and you don’t need to leave the house to collect your sample, when you weigh that against the potential impact of advanced cancer the number of Australians getting tested is far too low.”

Sally hopes her story will raise awareness of bowel cancer and encourage more people to take part in screening:

“I’m sure if we offered to turn back time for every bowel cancer patient to have early screening and an early diagnosis – they would take the opportunity in a heartbeat. The later the diagnosis, the more invasive the treatment needs to be, and the lower the survival rate.”

References

2. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30147-5/fulltext
3. https://www.aihw.gov.au/reports/cancer-screening/national-bowel-cancer-screening-program-monitoring/contents/table-of-contents

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The idea of starting the year with a clean slate, particularly a clean bill of health, is appealing. We run through five health tests that might be worth considering.

The type 2 diabetes, or HbA1c, test

A relatively new test, the HbA1c test looks at ‘glycated haemoglobin’ in your body, averaged over the last three months, to determine if you have diabetes, prediabetes or healthy levels of HbA1c.

With 1.2 million Australians living with diabetes, a further 500,00 suspected of having undiagnosed diabetes and with the condition projected to grow to 3.5 million by 2033, it’s a real spectre on the health horizon. Someone can live with diabetes for 7 years before any symptoms become apparent, causing damage to the body in the meantime.

Take the 2-minute AUSDRISK diabetes assessment to learn if you might be at risk and need to book in for a test.

The skin cancer, or melanoma, test

Australians have the highest rates of skin cancer in the world, and melanoma is the third most common cancer in Australia, and two-thirds of Australians will be diagnosed with skin cancer by the time they’re 70.

A visit to the doctor or skin specialist to check spots and for other symptoms is your first port of call. If required, the doctor may perform a biopsy to test for any suspected skin cancer.

Bowel cancer screening

Every year 17,000 Australians are diagnosed with bowel cancer, but the good news is that bowel cancer is one of the preventable cancers, meaning with changes to diet and lifestyle, the dangers can be reversed or mitigated.

Of those diagnosed with bowel cancer, 93% are aged over 50. If detected early, 9 out of 10 bowel cancer cases can be successfully treated. And in a stroke of further good fortune, the Australian government runs a free bowel screening test program, sending a testing kit to your house, no less, which you can conduct and return at your own convenience.

Cholesterol test

Cholesterol is no good for the old heart and brain, so if you’re over 45 you want to check that out – particularly if high cholesterol and heart disease run in the family. For those under 45, other risk factors include smoking, excess weight, diabetes, high blood pressure renal failure, or being of Aboriginal or Torres Strait Islander descent.

A cholesterol test involves taking a blood sample and looking for LDL-C, a bad cholesterol (there are good ones too) which collects in the walls of blood vessels.

STI and related tests

No, young people do not escape testing. If you are sexually active you might want to consider testing for chlamydia, syphilis, or gonorrhoea, as well as the three H’s: human papillomavirus, HIV and hepatitis.

STIs are on the rise in Australia and often symptoms will be missed. If not detected and treated the health effects can be significant. More detail on how these tests work can be found here.

While GPs are often the first port of call for someone concerned about a medical condition, and where test referrals are made, it’s the pathology lab where a diagnosis is determined.

‘There are plenty of health conditions out there of concern,’ says Victorian pathologist, Dr David Clift ‘but the good news is that a lot of these conditions are preventable and treatable.’

‘Certainly, the five conditions mentioned here are preventable. If you haven’t had a test ever or for a while and have concerns, it’s good to know with Australia’s leading-edge pathology sector that you can have a simple test and set your mind at ease for the coming year.’

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FOFO, also known as health information avoidance, refers to a propensity amongst part of the population to avoid health testing for fear of finding out they have a serious medical condition that will then require medical treatment.

This may help explain why less than 50 per cent of free bowel cancer screening tests – sent by the federal government to those between the ages of 50 and 74 since 2006 – are returned for lab analysis.

To be sure, there are other reasons for not returning these potentially life-saving tests, such as the belief that nothing is wrong, being time poor, having other priorities, no family history of bowel cancer, or the old chestnut, I couldn’t be arsed (pun intended).

But as recent studies have shown, fear is an important factor that can make for irrational decisions.

A recent study at the University of Florida recognises that there can be a gulf between the medical profession extolling the good news that early detection means earlier intervention and better health results, and the psychological terrain those suffering FOFO might inhabit.

While facts certainly play a major role in making the case for screening and early detection of conditions like bowel cancer, the impediments to testing are often psychological rather than simply factual.

Specialist Gastrointestinal Pathologist, Dr Nick Musgrave, notes “It’s well established that the stage of bowel cancer at diagnosis is the biggest determinant of outcome and many early cancers are curable. So we want to understand what will encourage someone to complete the faecal occult blood test so that they will get a diagnosis early.”

The University of Florida researchers found when one group was asked to list three reasons for knowing and three for not knowing about their risk of developing heart disease, only 28 per cent opted to remain in ignorance of their risk, while in the control group, who were asked simply to list eight facts about heart disease, 55 per cent didn’t want to know their health risk.

What this suggests – which is valuable for broader campaigns around pathology testing – is that a list of frightening facts by themselves are not sufficient to convince people to change behaviour. Weighing up the pros and cons in a considered way, the study suggests, leads to a more favourable attitude toward testing, which in turn leads to better health outcomes.

We thought we’d put that theory into practice here by listing some common objections, laying out the pros of taking part in the National Bowel Cancer Screening program, and allowing you to fill out the cons. Let’s see how the case for testing stacks up.

Why should I do the bowel cancer screening test? I have no family history of bowel cancer

Pro: Most people who develop bowel cancer have no family history of it so that’s no indicator of whether you’ll develop bowel cancer.
Con:

I live a healthy lifestyle so don’t anticipate I’d have a problem

Pro: While bowel cancer risk is increased by factors such as smoking, excess alcohol intake, unhealthy diet, and lack of exercise, ageing and other factors such as being overweight also have a bearing.
Con:

I have no symptoms of bowel cancer

Pro: the National Bowel Cancer Screening Kit can detect bowel cancer before it forms, and before there are symptoms, giving you a massive treatment advantage. Bowel cancer kills eighty Australians a week, but most could have been avoided by early detection.
Con:

What if I find out I do have bowel cancer?

Pro: The good news is, with early detection the cancers can be successfully removed, with up to 90 per cent chance of survival. If left untreated, cancers can develop and spread to other areas of the body.
Con:

What do I gain/sacrifice by taking the test?

Pro: the test is free, quick and can be done in the comfort and privacy of your own home. Test results are returned in a couple of weeks. The test provides piece of mind and early detection provides an enormous advantage in terms of treatment.
Con:

*Image credit: http://pooh-sticks.com/

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It reveals poor knowledge of bowel cancer risk factors and screening recommendations among Australians aged 18 – 85 years, increasing the risk of missed tests and delayed diagnosis.

• Almost half (47%) of respondents aged 50+ were unaware of the recommended bowel cancer screening test
• Only 39% of respondents knew how often the test should be undertaken
• Less than a third of respondents knew the recommended minimum screening age
• Only 24% of respondents correctly identified bowel cancer risk factors

Bowel cancer is Australia’s second biggest cancer killer. It is estimated that 33,000 Australians will die of bowel cancer by 2025. In Australia there are 15,253 people diagnosed with bowel cancer each year and 2,186 of these people were under 55.

According to the study, fewer than a quarter of those surveyed could identify the risk factors that could increase their chances of developing bowel cancer.

Lifestyle related risk factors for bowel cancer include; smoking, alcohol consumption, being overweight and a diet low in fibre. These risks can all be modified by changes to lifestyle.

Other risk factors are age, genetics, personal and family health history. People with one or more of these risk factors should speak to their GP about bowel cancer screening.

At the time of the study the National Bowel Cancer Screening Program was underway (Dec 2015 – Mar 2017), and this invited eligible Australians to undertake at-home screening tests.

“Affecting men and women, young and old, bowel cancer often develops without any warning signs,” said colorectal cancer surgeon Graham Newstead AM.

“That’s why Australians need to know the risk factors, make necessary lifestyle modifications, participate in screening appropriate to their level of risk, and be on the lookout for symptoms suggestive of bowel cancer,” Dr Newstead said.

“Unfortunately, the report shows that knowledge of bowel cancer risk factors and screening recommendations remains dangerously low,” said Bowel Cancer Australia Chief Executive Julien Wiggins.

“Studies show participating in screening can reduce your risk of dying from bowel cancer by 16%.
From age 50, Australians can take advantage of the taxpayer-funded National Bowel Cancer Screening Program (NBCSP).

However, people are encouraged to speak to their GP about individual circumstances and participate in screening appropriate to their personal level of risk.”

Possible symptoms of bowel cancer may include:

• A persistent change in bowel habit, especially going to the toilet more often of having looser, more diarrhoea-like movements
• Blood in the bowel movement or rectal bleeding
• A change in appearance of bowel movements (e.g. narrower stools or mucus in stools)
• Unexplained anaemia causing tiredness, weakness or weight loss
• A lump or swelling in your abdomen

It is important to note that these symptoms are not necessarily indicative of cancer, other medical conditions, some foods and certain medications can also cause these changes.

Pathology testing, physical examination and other diagnostic tools can help doctors to determine the cause of any symptoms. Anyone experiencing symptoms such as those listed should talk to their doctor about them.

“When diagnosed at the earliest stages, 90% of bowel cancer cases are treatable,” Mr Wiggins said.

“But early diagnosis is only possible if patients with a positive screen result or symptoms suggestive of bowel cancer can access the necessary follow up, such as colonoscopy, within the recommended timeframe,” said Mr Wiggins.

“Symptoms suggestive of bowel cancer require timely investigation via colonoscopy, so don’t wait until it’s too late,” urged Mr Wiggins.

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What is Lynch syndrome?

Lynch syndrome is an inherited genetic mutation that means a person has an increased chance of developing certain cancers during their lifetime, often at a younger age than the general population.

The genes in question are mismatch repair (MMR) genes including MLH1, MSH2, MSH6, PMS2, and EPCAM-TACSTD1. These genes are responsible for fixing mistakes made when DNA is copied to prepare for cell division, which is part of the body’s everyday repair and growth mechanism.

Usually a person will inherit two working copies of these genes, one from each parent. People with Lynch syndrome inherit a working copy and a non-working copy.

The defects in the MMR genes mean that copied DNA can contain mistakes – as cells divide, these errors accumulate and uncontrollable cell growth may lead to cancer.

Many cancers are associated with Lynch syndrome, including ovarian, stomach and pancreatic cancer. The most common cancers associated with the condition, however, are bowel cancer and endometrial cancer.

Pathology testing

Lynch syndrome is diagnosed via a blood test. It is an inherited condition and parents with Lynch syndrome have a 50% chance of passing the condition on to their children. Lynch syndrome cannot skip a generation so if a child does not inherit it, they cannot pass it on to their own children.

Risk factors, aside from a family history of Lynch syndrome, is a strong family history of cancer occurring at a younger than normal age such as below age 50. The first step in being tested is to speak to a doctor about your family history of cancer. If appropriate, a doctor will refer patients for genetic counselling and testing.

Lynch Syndrome Australia advises using their “3,2,1 rule” to help people decide if they are at risk:

3 or more family members (including you) have been diagnosed with a Lynch syndrome associated cancer.

2 consecutive generations or more are affected.

1 affected family member is diagnosed with a Lynch syndrome associated cancer before 50 years of age.

Benefits of testing

It is an individual decision whether or not to be tested for Lynch syndrome but a diagnosis can help someone to manage their cancer risk and can potentially help family members.

If deemed at risk, a person will be referred to a specialist service such as a hereditary cancer centre. A genetic counsellor talks through the options and answers any questions to help someone make their decision about getting tested.

If diagnosed, depending on which gene mutation someone has, enhanced monitoring or preventative procedures may be offered. For example, for people with an MLH1 or MSH2 gene mutation, annual colonoscopy is recommended from age 25, or age 30 if the mutation is in the MSH6 or PMS2 gene. For women with a TAH-BSO mutation, hysterectomy and oophorectomy (removing the ovaries) is recommended before the age of 40.

Lynch syndrome can also mean that cancer advances more quickly, so a diagnosis can help someone catch cancer earlier giving a better chance of successful treatment.

As people with Lynch syndrome are more susceptible to cancer at a younger age, a diagnosis can affect some life decisions, in particular for women of child-bearing age.

Lynch Syndrome Australia is committed to raising awareness about the condition so that early diagnosis can help people be better informed and make choices about their health and their future.

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The trial will assess the accuracy of the non-invasive test in diagnosing colorectal cancer at an early stage, with the aim of improving survival rates of bowel cancer, which is the second most common cancer killer in Australia.

Previous research has been promising but as this may be the largest trial of its kind it may help make the case for a less invasive test to improve participation rates for screening.

Although there is a screening program for bowel cancer in Australia, a faecal test is off-putting for some patients. The faecal test does not diagnose cancer but looks for blood in the stool which then requires further investigation.

Similarly the breath test would not confirm a cancer diagnosis but detects exhaled compounds in the breath that are linked to cancer and require follow up.

The trial is being run in collaboration with the University of Warwick and the University Hospital Coventry. A smaller pilot study that showed sensitivity of 88 percent in detecting Volatile Organic Compound (VOC) biomarkers for the disease.

The pilot also showed sensitivity of 62 percent for detection of advanced adenomas, a pre-cancerous stage of colorectal cancer, representing a substantial increase in the rate of detection when compared to the faecal tests.

The post Could this technology detect bowel cancer early by “sniffing” your breath? first appeared on Know Pathology Know Healthcare.

The tragedy of bowel cancer deaths is that the condition has incredibly good outcomes if it is detected and treated early. It is Australia’s second biggest cancer killer yet 90% of cases can be treated successfully if detected early. This figure decreases to just 15% for stage-four diagnoses.

Detection is heavily reliant on pathology, which is essential both for faecal screening tests and to identify cancerous polyps on biopsy. In fact, every case of cancer is diagnosed by pathology.

The report also states that 30 Victorians a day died from cancer last year and obesity was a major risk factor. Over 1,000 of the new cancers diagnosed last year in Victoria were obesity related, which means an opportunity exists to intervene.

Cancer Council of Victoria CEO Todd Harper said bowel cancer was one of the cancers that people could reduce their risk factors for if they made lifestyle changes;

“It’s important for people to maintain a healthy body weight, be physically active and also eat a healthy diet. Reducing alcohol consumption is also important.”

Mr Harper also said more people need to participate in free screenings. Currently only around 38% of eligible Victorians are participating in the bowel screening program, which is available to everyone aged over 50. This could be due to people being put off by the test.

“I think we need to get across to people that this is a simple test that can save your life,” he said.

The post “A simple test can save your life”: bowel cancer still second biggest cancer killer first appeared on Know Pathology Know Healthcare.

As in many areas of medicine, genetics is driving the improvement in cancer care and pathology is integral to making new discoveries about the genetic characteristics of cancer. New pathology tests are also developed as part of keeping pace with advances in knowledge and treatment.

Bowel (or colorectal) cancer is the second biggest cancer killer in Australia.

One type of drug that is used to treat bowel cancer is known as an epidermal growth factor receptor (EGFR) inhibitor.

EGFRs are receptors that are present on the cell membrane. They receive chemical signals from outside the cell and have an important role in controlling normal cell growth. If a change happens within the receptor they can malfunction and cause unregulated cell division. This can be responsible for cancer growth.

The EGFR inhibitor drugs work by suppressing these malfunctioning receptors and therefore stalling progression of the cancer.

However, in some people the drugs do not work well and the cancer resists their effects and continues to grow. Research has shown that resistance can be predicted by pathology testing of the cancer to look for mutations in a group of genes known as RAS genes.

Tests are conducted on a biopsy of the cancer to look for certain mutations in these genes meaning that the cancer will not respond to the EGFR inhibitors.

This information can avoid prescribing drugs that will have little benefit and are expensive.

The test also saves time; allowing doctors to explore other treatment avenues for these patients more quickly.

The recently released Economic Value of Pathology report included evidence about the falling mortality rate for colorectal cancer and the benefits of RAS testing for patients and health spending:

“expanding testing to include all RAS mutations and limiting subsidy of cetuximab (an EGFR inhibitor) to those patients demonstrated to have no RAS mutations both reduces harms and improves health outcomes, and the cost of RAS mutation testing is negligible compared to the cost of therapy for patients with metastatic colorectal cancer”.

According to Bowel Cancer Australia, who are proud supporters of the Know Pathology Know Healthcare initiative, all advanced bowel cancer patients should undergo a RAS biomarker test to help determine their treatment options, minimise side effects, maximise survival rates and reduce toxicity exposure.

“Increased access to RAS testing will ensure the right treatment will be available at the right time for metastatic bowel cancer patients,” said Bowel Cancer Australia CEO, Julien Wiggins.

The current survival rate for bowel cancer is 67% and although this has risen by 20% in the last 30 years, the cancer still kills more than 4,000 Australians a year.

Bowel cancer screening programs rely on pathology, diagnosis is made by pathology and tests to guide treatment are conducted by pathology.

As medical research and the fight against cancer continue, pathology testing remains at the forefront saving time, money and ultimately, lives.

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Pathology testing saves lives and money according to a new report released today. Half the Australian population had a pathology test in the last 12 months. According to the report a third of the rise in tests requests is from doctors as they seek to prevent or minimise the impact of disease.

Pathology testing is central to controlling important, growing chronic diseases including diabetes. Managing diabetes without pathology has been compared to trying to drive a car without a steering wheel.

One in two GP visits involves a request for pathology tests. 60% of GP referrals for pathology relate to preventative health strategies and management of chronic illness. The report notes that 32% of the increase in clinical demand for pathology is due to preventative health treatments.

The Economic Value of Pathology is a meta-analysis conducted by the Centre for International Economics that examines three key health areas: diabetes, heart attack and colorectal cancer. Pathology is practiced in laboratories and is a largely unseen area of healthcare. The report was commissioned by Pathology Awareness Australia to quantify the value of investment in pathology.

70% of medical decisions rely on information from pathology testing and all cancer diagnosis is made by pathology investigations.

Pathology includes tests on blood, urine, swabs and biopsies, and provides detailed information to doctors. The report says Australia has among the highest quality pathology in the world and results produced by a workforce of 35,000 underpin the standards of overall healthcare.

Enhanced diagnostic technologies combined with the ageing population and an increasing focus on prevention, has spurred growth. Men over 75 in particular now access more testing for chronic disease management and preventative health strategies.

The total cost of delivering 500 million pathology tests per year across the community and in hospitals is estimated at 3 per cent of total health spending.

Report author Sarina Lacey from the Centre for International Economics says the findings highlight the need to invest appropriately in pathology:

“Pathology offers tremendous return on investment. With so many people with and projected to develop diabetes and other chronic conditions, it’s important to make smart, cost-effective decisions before health problems become expensive to manage. Getting health expenditure in the right areas makes good economic sense and pathology can make this happen.”

Pathology testing a defence against ballooning diabetes treatment costs

Diabetes related testing accounts for 10.5% of the growth in requesting from general practice and 6% of all GP orders for pathology.

1.7 million Australians have diabetes and this is forecast to rise to 3.5 million within 17 years. Diabetes complications account for 14% of preventable hospitalisations, 67% of Australian adults with diabetes have high blood pressure, and 68% die of heart disease or stroke.

Pathology tests are integral to diabetes prevention programs. The report notes that Type 2 diabetes prevention programs can save between $2,600 and $5,300 per life year.

The Haemoglobin A1c (HbA1c) blood test indicates the level of long-term blood sugar control. Proactive action on regular HbA1c results can help keep levels normal in people with diabetes. A small sustained decrease can reduce the cumulative incidence over five years in: end stage kidney disease by 40%; amputation by 21%; advanced eye disease by 43%; and heart attack by 16%.

Pathology Awareness Australia Ambassador A/Prof Graham Jones is a Pathologist at Sydney’s St Vincent’s Hospital. He specialises in testing for diabetes and says,

“Pathology underpins most of healthcare – you can’t do without it. Diabetes is defined by pathology tests – we have no other tools to see if we’re winning against the condition. Trying to manage diabetes without pathology is like trying to drive a car without a steering wheel!”

Sturt Eastwood, CEO of Diabetes NSW says,

“Diabetes is a significant, expensive problem that continues to grow at an alarming rate. Helping people prevent diabetes or reduce their complications is a win for the individuals involved and for the economy as a whole. Pathology testing is a vital part of diabetes management.”

$167 million per year can be managed down by ruling out heart attacks in Emergency Departments

Patients with chest pain account for approximately 10% of Emergency Department (ED) presentations. Approximately 1 in 5 cases will be for heart attack with the remainder for more benign conditions. At current ED attendance rates, $167 million per year is required to triage chest pain patients prior to hospital admission or direct discharge.

The Troponin blood test is an essential tool to diagnose and rule out heart attack. Recent advances in Troponin tests have allowed costs to be partially managed down. Newer Troponin tests may allow 40% of chest pain patients to be discharged earlier if used to their full potential.

Smart testing matches patients with the best therapies

Personalised medicine has revolutionised cancer care, and is only possible because of pathology. Pathology can now test the genetic characteristics of cancer to determine if a treatment will work on a patient.

Smart tests can match the patient with the appropriate drug therapy. The report notes that the KRAS and RAS mutation gene tests have been found to provide net cost savings to the Australian Government by ruling out treatment for patients that won’t respond well, and reducing harm and improving outcomes for patients that will.

This has underpinned dramatic improvements in survival and reductions in deaths from colorectal cancer over the past decade, with the 5–year survival rate for metastatic colorectal cancer having risen dramatically up to 67 per cent.

Download the full Value of Pathology report or an infographic including key pathology facts.

The post The Economic Value of Pathology report first appeared on Know Pathology Know Healthcare.

A recent report commissioned by Bowel Cancer Australia has highlighted the risk of developing bowel cancer.

The report 8 million Australians in the crosshairs of colorectal cancer demonstrates the need to focus on early detection as bowel cancer affects 15,000 Australians annually, with 4,000 deaths per year.

The disease is most common in people over 50 and so this age group has been targeted by a number of national screening programs.

Pathology testing plays a central role in bowel cancer screening and early detection.

The test used in the screening programs is the Faecal Immunochemical Test (FIT), which looks for traces of blood in the faeces. This blood may not be visible to the naked eye.

The test kit contains the simple tools needed for a person to collect samples of their faeces and send these off to be tested in a lab.

If the test comes back positive, the next step is likely to be a colonoscopy procedure where a long flexible tube with a camera at the end is inserted into the bowel for further examination.

The FIT is not the limit of pathology’s role in bowel cancer.

Dr Penny Yarrow is a pathologist based in Hobart; “Pathology is needed throughout the bowel cancer journey from screening through to diagnosis and monitoring a patient during and after treatment.

The actual diagnosis of cancer is made by a pathologist. A tissue sample taken from the patient’s bowel will be examined under the microscope to determine if cancer or a precursor lesion is present. If cancer is present and an operation is required to remove it, a pathologist will again examine the tissue to establish how far cancer has spread and what stage the cancer is at,” said Dr Yarrow.

Pathology testing is also used after diagnosis to help doctors determine the best course of treatment. For example, genetic or molecular tests can show mutations in particular genes which affect how cancer may respond to certain drugs. Testing is also performed to determine if a cancer may be the result of a genetic predisposition.

Bowel Cancer Australia CEO Julien Wiggins said: “Bowel cancer is more common than many people realise affecting 1 in 12 Australians at some point in their life. It is the second most common cancer in Australia but unfortunately does not have as good a survival rate as other common forms of cancer.

This is why screening and associated pathology tests are so crucial. It gives us that all important chance to get the cancer early, or helps determine tailored treatment options.”

The report also showed that rural and remote areas had higher mortality rates in part because these communities contain more people in the high risk age group of 50-79 years.

Bowel Cancer Australia is urging people to “get over the yuck factor” and take the test.

^{Image: Bowel Cancer Australia https://www.bowelcanceraustralia.org/bowel-cancer-facts} 

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