Questions raised over the best way to screen and assess people at risk of bowel cancer

| 20.07,18. 02:07 PM |

Questions raised over the best way to screen and assess people at risk of bowel cancer

Photo: Bowel cancer screening kits are mailed to Australians after they turn 50. (Supplied: Bowel Cancer Australia)

An Australian doctor says he believes a risky type of colon polyp that can lead to bowel cancer may be more common than previously thought.

It was initially thought serrated polyposis syndrome — which can indicate an increased risk of bowel cancer — was quite rare, at around one in 3,000 people, but in recent years research has suggested it may be more common.

A study by gastroenterologist, Stuart Kostalas, which has been submitted for consideration at a medical conference in Europe later this year, may add weight to this idea.

The research assessed almost 4,000 patients who had a colonoscopy at Dr Kostalas's Port Macquarie practice on the New South Wales mid-north coast between January 2015 and March 2018, and detected serrated polyposis syndrome in nearly three per cent.

"The results are due to a range of factors, including improved technology and detection methods, better training plus improved bowel preparation," Dr Kostalas said.

Colorectal surgeon and director of Bowel Cancer Australia, Graham Newstead, said these types of polyps have been increasingly on the medical radar in recent years.

"Jeremy Jass … a pathologist at St Marks Hospital in London identified these [polyps] as being different some years ago," Dr Newstead said.

"I wrote an article showing how much more risky they were compared to the regular polyps in the bowel.

"They are very hard to see. They grow like a flat polyp and are not that different in look from the regular lining of the bowel, so we can miss them. And they do have a higher risk of cancer."

Dr Newstead said because of their increased cancer risk patients with the polyp required regular colonoscopies.

Results raise questions about screening

Dr Kostalas said he believed Australia's bowel cancer testing guidelines may need a refresh so that sessile serrated polyps can be detected earlier.

"A different approach to screening may have a role," he said.

"Certainly the American guidelines recommend average-risk individuals choose either optical [colonoscopy] or non-invasive [stool testing].

"Perhaps Australia could follow this lead rather than using non-invasive screening for average-risk individuals."

Dr Newstead agreed that testing guidelines need to be revised, and added that family history plays an important role in determining whether colonoscopies are required.

"If their family has had either multiple polyps, or had a [colostomy] bag created … or any other reason that makes you suspicious, there could be an increased indication.

"In a perfect world that has the resources and doesn't mind costs, we need colonoscopies on everybody."

Dr Kostalas said there was also a need for better guidelines around patients who are detected with sessile serrated polyps to determine how often they need to be tested after a positive result.

"What we are aiming for is that real goldilocks area … not too often, not too little, but just right. We're hoping that will happen in eventually defining guidelines," he said.

Dr Kostalas said better guidelines would allow doctors to specify to patients in certain risk categories how often they should be tested.

"Each colonoscopy has risks and that's what we are trying to balance."

Dr Newstead said more research on sessile serrated polyps was required.

"There isn't the literature on the sub groups of sessile serrated adenoma patients to say 'You should have a colonoscopy every X, you should have one every Y'," he said.

"So far we colorectal surgeons are considering these on a case by case basis, with good background information."

Patients need to share colonoscopy experiences

Meanwhile efforts are continuing to increase the number of people who have bowel cancer screening tests.

Dr Newstead said more work needed to be done to reduce the stigma around bowel cancer and encourage day-to-day conversation.

"Less than 40 per cent of the Government screening tests which are sent out get returned because people look at them and say 'eew', and throw it in the bin saying, 'I'm not going to do all that'," he said.

"It's terribly simple; poo, paint, post — it's so easy.

"We spend our lives talking about what we are going to put into our mouths and we don't discuss what comes out the other end, because it's yucky, but it you've had a baby you know what yucky poo is anyway, so we all get used to it, and we need people to be aware."

Dr Kostalas said he believed encouraging people to talk about their colonoscopies was important too.

"I'm hoping we can get word out there with people who have had the procedures," he said.

"People can say, 'I've had it done, it was easy, it wasn't too onerous, they found a polyp and it reduced my risk of cancer'."


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