It could not be easier: In Australia, around their 50th birthday, many people get a special gift in the mail from the Australian Government – a free bowel cancer screening test kit. The kit, also known as a faecal occult blood test or stool test, is done by you in your own home. It's non-invasive, painless, private and easy. So why is it that women are more likely to have a mammogram or cervical screening test than do their own bowel screening test?
In 2017, bowel cancer (also known as colorectal cancer) was second to breast cancer as the most common type of cancer diagnosed in women in Australia, and was the third most common form of cancer-related death, after lung and breast cancers.
You can reduce your risk of bowel cancer and, when detected early, nine out of 10 cases can be treated successfully. Despite this, national screening rates currently sit at 41%.
The 2017 Jean Hailes Women's Health Survey indicated that while 79% of women in Australia had undertaken a Pap smear test and 54% had had a mammogram in the past five years, only 24% of women had done a faecal occult blood test.
This is in stark contrast to cervical cancer – which in 2017 ranked 14 and 19 respectively in terms of incidence and mortality – and is at an historical low due to the highly successful Pap smear screening campaign (now replaced by the cervical screening program) over the past 20 years.
Which begs the question: is having to get close enough to one of your own stools (poos) to take a sample – but not close enough to actually touch it – still the main reason women are putting off the 'poo test'?
Gastroenterologist Dr Suzanne Mahady says research suggests a few reasons behind the reluctance, including "breaching social norms, fear of bad news if the test is positive [even though a positive test is very unlikely to mean cancer] and a reluctance to do the test at home."
Cancer Council NSW also found that people from disadvantaged groups and/ or non-English speaking backgrounds were among those less likely to access screening. Dr Mahady says some people don't do the test because they feel well. However, polyps – small growths on the lining of the bowel that can develop in bowel cancer – are generally too small to cause any symptoms.
"Bowel cancer may not cause symptoms until large, but its presence can be detected by the stool test," says Dr Mahady. "Given the high rates of bowel cancer in Australia, it's important that women commence bowel cancer screening at the age of 50 and continue on a regular basis."
Dr Mahady, who is also a senior lecturer at the School of Public Health and Preventive Medicine at Monash University in Melbourne, says data shows that one in 15 women will be diagnosed with bowel cancer by the age of 85. "Feeling well is not a reason to not do the stool test," she says.
She says that general practitioner (GP) referral for bowel cancer screening is a main factor in women getting the test done.
"Discuss bowel cancer screening with your GP, who can organise a stool test if indicated," Dr Mahady says. "Alternatively, stool testing kits are available in your pharmacy or can be ordered online from Bowel Cancer Australia.
"If the stool test is negative, then it's recommended to undertake the test every 1-2 years as part of an ongoing health check schedule. If the test is positive, you will be referred to a specialist such as a gastroenterologist for a colonoscopy to check inside the bowel for polyps or bowel cancer."
Even though age is a significant – and unchangeable – risk factor in developing bowel cancer, Dr Mahady says there are other ways to reduce your risk. "As well as regular screening, maintaining a healthy weight, exercising regularly, not smoking, limiting alcohol intake, and eating in a balanced manner are all methods by which women can reduce their risk of bowel cancer," she says.
The stool (poo) test involves obtaining two tiny samples from two stools passed at different times, but as close together as possible.
The stool test kit includes sampling sticks, transport tubes, ziplock bags and a reply paid envelope, so you can send your test to the pathology laboratory for testing.
Bowel cancer is thought to develop from polyps. The polyps do not cause symptoms. However, they can leak tiny amounts of blood, which is what the test looks for.
If a stool test is positive, a patient is referred for a colonoscopy to find and cut out the polyps, to stop them developing into bowel cancer. Like all tests, the stool test isn't 100% accurate. If you have a negative test but have symptoms that concern you, please see your doctor.
A colonoscopy is a procedure performed to visually examine the bowel. The test is performed under sedation and takes about 20-30 minutes.
A thin, flexible tube with a tiny camera attached (a colonoscope) is passed into the rectum. The camera lets the doctor look for polyps or cancerous growths in the bowel, and remove them.
You will usually be able to go home about two hours later, after the sedation wears off.
There is a small risk of a serious complication such as bleeding, so this test is generally done by specialists after discussing the risks and benefits. If a person has had polyps detected, they must have a colonoscopy every few years to ensure any new polyps are removed while small, before they develop into cancer.
The Federal Government is phasing in a bowel cancer screening program for people aged 50-74. People are sent a stool self-testing kit every two years.
If the result is negative, a person will not need to do the test for another two years. If positive, a letter will be sent to the patient and their GP advising them to refer for a colonoscopy.
By 2020, people between 50 to 74 years of age (around four million Australians) will be invited to screen each year. The government has estimated that this could save up to 500 lives annually, and drastically reduce the burden of bowel cancer in Australia.
For more information visit the Australian Government's Cancer Screening page.