Men are almost twice as likely to die of bowel cancer than women, writes Ciaran Brennan
JOKES ABOUT the probing gloved finger may abound in bar-room banter, but men are, quite literally, dying of embarrassment every single day in the Republic because of their reluctance to deal with the symptoms of bowel cancer and subject themselves to rectal examination.
"Yes, having a rectal examination is not everyone's idea of a good day out but it can save your life," says the Irish Cancer Society (ICS).
While not painful, it can be uncomfortable and embarrassing.
"People don't like the thought of the examinations. It's not like going for a blood test," says Liz Tobin, a nurse with the ICS. "It can be an embarrassing thing to talk about and a lot of people are being diagnosed at a late stage when survival rates wouldn't be the best."
Like most cancers, bowel cancer is not gender specific but incidences of the disease are higher among men.
"It is more prevalent in men than women," says Tobin.
Cancer of the large bowel is the second most common cause of death from cancer in Irish men, according to figures released by the National Cancer Registry in Ireland (NCRI) in 2003.
"At the moment the risk of this cancer is not changing for men, while declining in women. While the risk for both sexes was almost the same in the 1960s, men are now almost twice as likely to die of bowel cancer than women," it says.
New cases of bowel cancer are increasing by 1.5 per cent a year in men, the NCRI found. If that trend continues, bowel cancer will be killing more men than lung cancer by 2010, it says.
"There is not much sign of any narrowing of the gap between men and women at the moment," says Dr Harry Comber, director of the NCRI.
And it appears that bowel cancer is a much more serious problem in the Republic than among most other European countries. Only Austria has a slightly higher incidence for men.
"We have a relatively high incidence," says Comber. "We would probably have the second highest in terms of incidence in western Europe."
The latest statistics from the NCRI shows that 2,184 new cases of bowel cancer were diagnosed in 2005 and nearly 60 per cent of these were among men.
The bowel, or the gut, which digests and absorbs food has two parts - the small and large bowel.
Cancer more commonly appears in the large bowel and rectum, which is the last part of the gut.
Bowel cancer is common and treatable when it's caught early. Yet, approximately half of the 2,184 cases in 2005 were diagnosed at an advanced stage.
While guts can play up at the best of times for a variety of reasons, there are some warning signs that shouldn't be ignored such as blood in your stools; bleeding from the back passage or blood on toilet paper; a change in the way your bowels are working, such as diarrhoea or constipation, that lasts more than a month; a regular bloated feeling; trapped wind or fullness; a feeling that there is something left to pass even after you go to the toilet; pain or discomfort in your stomach or back passage; weight loss for no good reason; or increasing general tiredness or weakness.
Some of the risk factors for the disease could help to explain the high rates of bowel cancer in Irish men.
Diet would seem to be a key factor. The National Cancer Institute in the US states that there is strong evidence that "diets high in total fat, protein, calories, alcohol and meat and low in calcium and folate, are associated with an increased incidence of colorectal cancer".
Figures from the NCRI show that men in the Republic consume this type of diet to a much greater extent than women. Irish men are more likely than women to be overweight, not to be on weight-reduction diets and to eat fried food. In European comparisons, Irish men are at the higher end of the obesity scale.
"There is a fairly obvious connection between diet and cancer of the bowel," says Comber.
"There was a very big study done in Europe called the Epic study looking at dietary factors and that seems to have established that a high-fibre diet protects against colorectal cancer. The average Irish diet would be fairly low in fruit and vegetables. It tends to be high in carbohydrates and meat and that may well be a reason.
"Women's diet in Ireland is marginally healthier than men's. Probably it is a pattern that is changing a little but women would have been more weight conscious and certainly more diet conscious."
There is a team approach to the treatment of bowel cancer, according to the ICS.
Surgery is the main form of treatment but is increasingly combined with chemotherapy and radiotherapy treatments to give the best possible outcome.
"Bowel cancer can be very well treated and cured if it is caught at an early stage, stage one or two," explains Tobin. "At stage three and four when there is spread, cure rates are very low."