Preventing cancer and detecting it early

Bowel cancer is the third most common cancer in Australia. Every year there are about 16,000 new cases diagnosed and about 4,500 deaths. Research has shown that the at-home bowel cancer screening kits can reduce deaths from bowel cancer by 15-25%. Yet only about 41% of people use them and send them back. If you do send off your sample, a pathology lab will look for microscopic traces of blood that can’t be seen by the human eye. Blood is a sign that you might have bowel cancer or the earlier stage—a polyp—which may or may not develop into cancer. Polyps can be removed before they even become cancer, and bowel cancer that has already developed can be caught and treated early, which dramatically increases your chances of survival.

The test is extremely simple. You do a poo, poke it with the stick provided, seal the stick in the container, put it in the reply-paid envelope, and drop it in the mail. The kit lasts about a year before it expires. But 59% of the population don’t do it. Why? For some people, the idea of dealing with their poo is repulsive, they don’t understand the importance, they put it off in perpetuity, or they’re too busy. For others, there’s an accessibility problem—it may be too difficult with a particular condition or disability, like it is for many people who are blind or rely on wheelchairs.

Finding another way

Associate Professor Erin Symonds is one of the people working to increase participation in bowel cancer screening. Her research asks, ‘For people who don’t want to do the faecal test, would they do a blood test instead?’ People are familiar with having blood tests and could receive a referral in the mail. It would be more accessible and an alternative for people who can’t, or won’t, do the faecal test. It could also be taken with other blood tests—streamlining the process—and draw on the involvement of GPs, who could refer their patients over 50 years old to the screening test. Erin suggests a scenario where a GP might say, ‘We need to test your cholesterol and, while you’re there, you’re not up-to-date with your bowel cancer screening test. So, let’s get that done too.’

Of course, Erin knows that different interventions are needed and there’s not going to be one solution. Many other interventions have been trialled—from financial incentives to screenings scheduled by location, rather than age.

Between the faecal test and the blood test, the faecal test is the best option for bowel cancer screening as it can detect polyps which, if caught, allows doctors to prevent the development of cancer before it happens. But the blood test is a good alternative for those unable to complete the faecal test; it still picks up bowel cancer at an early stage before it becomes symptomatic and less treatable—and some intervention is better than none. And it also has another use; Erin would love to see the blood test utilised in clinics to monitor patients after bowel cancer surgery and determine who needs chemotherapy. The test can detect traces of bowel cancer in a patient’s blood even when it looks like the cancer has been removed.

Extra screening, extra care

Another of her projects—called the SCOOP program—introduces additional screening for people with a family history of bowel cancer or who have been diagnosed and treated for bowel cancer or polyps in the past. This higher risk group usually have colonoscopies around every 3-5 years. Erin wants to introduce the faecal screening test the year after a colonoscopy and every two years afterwards. This test could catch any fast-growing bowel cancer that occurs between colonoscopies or anything that the colonoscopy might have missed. After all, surgeons are looking for small (about two millimetre) growths within the bowel, which is 1.5 metres of moving flesh with bends, folds and corners. As well as providing extra screening, the program also introduces computer software that nurses can use to keep track of when patients need colonoscopies or faecal testing kits—rather than relying on patients going to their GP and the GP managing the process.

Around 300,000 colonoscopies are performed in Australia each year on people at high risk of bowel cancer and 900,000 colonoscopies are performed overall. There are huge waiting lists and while bowel cancer is generally slow growing, waiting six months for a colonoscopy can make a difference. This can be anxiety-inducing for people—particularly those experiencing fear of recurrence, which is much too common in people who have had cancer. Erin explains, ‘People are really happy to take part in the screening test because they feel like it’s another level of care.’ 

What Erin’s team has noticed is that colonoscopies might be required only once every seven years, not five. More than 85% of the colonoscopies on people with a higher risk of bowel cancer find nothing. For the remaining 15%, the additional faecal tests can provide effective screening and indicate that they need a colonoscopy. Doctors and researchers around the world are taking note: the data says this program is safe and that it works. Fewer colonoscopies would reduce waiting times, cut costs for patients and hospitals, and negate the risks of the procedure. Anaesthetic always poses a risk and in older people, the bowel gets thinner and the medical device poses the threat of perforation.

Research that makes a difference

Since the start of her career, Erin has been working her way down the gastrointestinal tract—starting with a PhD on breath tests for conditions and diseases in the upper gut, to research into the small intestines, to nutrition and obesity projects focused on the gut, and now bowel cancer at Flinders. Much of her previous experience has been benchwork in a laboratory, so she’s pleased to now be working with clinicians. It’s a role where she can see the difference the research is making to people. Sometimes one of the patients from a study will call up and say, ‘I was involved in a study and because you caught my cancer early, I’m going to be okay. Thank you.’

Erin loves being amongst patients, doctors and other talented scientists. She even works with health economists, behavioural scientists and statisticians to make sure they’re using their data in the best way. The whole team are enthusiastic about the potential of this research, which could (and Erin believes, will) incite widespread change in how bowel cancer prevention is handled. ‘I just love what I do and I’m so lucky to have the job that I have,’ she says. ‘You put in extra hours, not because you need to get a job done but because you’re so excited about where it will lead.’