Detecting and treating cancer early is the aim of Ireland’s three free cancer screening programmes. And while there is good uptake for breast cancer and cervical cancer screening, only two in five people contacted for bowel cancer screening partake in BowelScreen, the national bowel cancer screening programme.
The low level of uptake comes at a time when the national bowel cancer screening service has just pointed out that three out of four cancers caught by the screening programme were detected at an early stage.
"These results show that BowelScreen can and does catch cancer early with 521 cancers detected and 13,000 polyps or adenomas removed which could have potentially developed into cancer," says Donal Buggy, head of services and advocacy with the Irish Cancer Society.
It is estimated that if all those eligible for bowel cancer screening availed of it, deaths from bowel cancer would be reduced by 30 per cent.
So why are many 60-69-year-olds deciding not to partake in free bowel cancer screening when about 1,000 people die from the disease in Ireland every year?
"Men often don't partake in bowel cancer screening because of fear, but for women, it's often the yucky nature of the test that puts them off," says Charles O'Hanlon, head of screening at the National Screening Service.
Bowel cancer is the second most common cause of cancer deaths in men in Ireland and the third most common cause of cancer deaths in women, accounting for 11 per cent of all cancer deaths in Ireland.
Bowel cancer screening involves sending a faecal sample by post to BowelScreen, which will then be tested for blood, and the results returned by post within four weeks.
“People are sent a letter, inviting them to take part,” says O’Hanlon. “Then they phone to request a test, which is posted out to them. It’s clearly explained in diagrams exactly what to do.” If the test results are positive, a free colonoscopy is organised.
Point of contact
The cancer screening service is currently looking into ways to encourage more people to go for bowel cancer screening.
“We considered making GPs the point of contact, but people in Ireland often change their GPs,” he says. “We also have considered making pharmacies the contact point for bowel screening. Currently, we have teams who attend everything from Men’s Shed groups to the Ploughing Championships to raise awareness. There are also advertisements for BowelScreen on television, radio and in cinemas.”
Plans are currently in place to extend bowel cancer screening service to those aged from 55-60 and 69-74.
Social deprivation is the greatest reason why women don't come
Breast cancer screening is the longest-running cancer screening service in Ireland, with the first patients screened in 2000.
“The advantages of breast cancer screening have been known since the 1960s, but it really was Swedish studies in the 1980s that proved a 30 per cent reduction of mortality with population screening,” says Prof Ann O’Doherty, clinical director of BreastCheck, the national breast cancer screening programme.
In the early stages of the BreastCheck programme, O’Doherty says women who already had lumps were coming to screenings. “Some of them had ignored the lumps because they were frightened, but now there are five times the numbers of women getting treatment for breast cancer, and delayed diagnosis is very rare.”
Currently, women aged 50-64 are screened for breast cancer, although over the next five years, women up to age 69 will also be included in the screening programme.
O’Doherty is keen to point out that there are advantages and disadvantages to breast cancer screening.
“We catch cancers earlier,” she says, “which means women have less invasive surgery and less chemotherapy. But we miss women who get cancer in the interval between screenings, and women feel very let down when this happens.”
Prof O’Doherty says that because mammography is not 100 per cent specific, a women maybe called back for reassessment of an abnormality within two weeks of her mammogram. “This happens to about one woman in 20 who has a BreastCheck mammogram. And around four in five of these women get normal results after reassessment.”
There is now about 70 per cent uptake of breast cancer screening in Ireland, down from about 75 per cent when the screening first began. “Social deprivation is the greatest reason why women don’t come,” says O’Doherty. “Some don’t come because they are too busy and others because they are fearful.”
Cervical cancer screening, which has been available nationally since 2008, is managed by and carried out by primary care teams. It is different to both breast cancer and bowel cancer screening in that the test can pick up the disease at an early pre-cancerous stage and treatment can then prevent cancer from developing.
Cervical cancer
Four out of five women currently participate in the CervicalCheck, the national cervical cancer screening programme.
These so-called population based screening approaches are only carried out on common cancers, in which early intervention will change the course of the disease, according to Prof O’Doherty. A reliable test must also be available.
“We are constantly evaluating whether screening should be introduced on cancers like prostate or lung cancer,” she says. However, in the case of prostate cancer, a reliable test hasn’t yet been found and the risks of screening doing more harm than good – ie with invasive procedures and side effects – prevents it from being introduced.
Meanwhile, the big public health message in all of this is that those who fall into the age groups for which breast, bowel and cervical cancer screening is offered should avail of it.
For information on BowelScreen, the national bowel cancer screening programme, see bowelscreen.ie.
For information on BreastCheck, the national breast cancer screening programme, see breastcheck.ie.
For information on CervicalCheck, the national cervical cancer screening programme, see cervicalcheck.ie.
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