New Zealanders are being penalised by their GP's and District Health Boards (DHB's) for being proactive with their bowel health. In a joint statement released in July 2018 from National Bowel Screening Programme Clinical Director Susan Parry and GP lead Dr John McMenamin, they stated that individuals who purchase their own pharmacy screening kits will not be eligible for further investigation through their GP or DHB's.
"One of the consequences of increasing awareness about bowel screening appears to be that some people are buying FOBT self-testing kits, such as those available from pharmacies. The expectation is that asymptomatic individuals, who get a positive result from a self-purchased kit, are entitled to further investigation through the public health system. This is not the case," it said.
Bowel Cancer Foundation CEO, Georgina Mason said this 'exclusion' by the National Screening Unit is why the charity had developed their own National Screening Programme.
"We are here to help all those New Zealanders who are rejected by DHB's and do not qualify for free national screening under the governments new screening rules."
One of the reasons why Kiwi's appear to be taking their health into their own hands is that the Free National Bowel Screening Programme is currently available in only 7 of the 20 DHB's across New Zealand.
The programme has been promised to be rolled out progressively across all District Health Boards before 2021.
Recent media reports suggest bowel cancer is on the rise among young people but the Governments Free National Bowel Screening Programme is only available for those between the ages of 60-74 years old.
When rolled out fully, the programme is expected to detect between 500-700 bowel cancers a year. This age group accounts for only 36% of all bowel cancers registered in New Zealand annually.
Georgina goes on to say...
"We cannot in good faith stand by and watch those who receive positive results left to flounder in the public system because they're either not old enough to join the Free National Bowel Screening Programme, or they qualify but their DHB has yet to roll out the programme in their area"
"In one instance we were able to help a member of the public who received a pharmacy supplied screening kit but was rejected by their DHB even though they were 74 years old and of the correct age for the National Bowel Screening Programme. They had previously had polyps removed and a family history of bowel cancer. As you can imagine it was quite a frightening time for this person. We were glad we could help organise a free colonoscopy within a few days"
The reasons for the National Screening Unit's advice has been listed as:
1. Screening using self-purchased kits does not include a systematic approach to the screening, diagnosis and treatment.
Bowel Cancer Foundation Trust advocates that everyone who purchases or is supplied a screening kit through their screening programme, involves their Doctor throughout this process as one point of contact is needed for their health history, follow-ups and results. If their Doctor is unaware of any private tests they cannot help to monitor their health at all times and follow up on their behalf. If a private colonoscopy is requested the patient's Doctor by is required to be notified. If cancer is detected the private gastroenterologist is required to notify the patient's doctor for follow up treatment.
2. There is no structured or timely support for people who return a positive FOBT result. Most will not have cancer but may be unduly alarmed.
(Bowel cancer Foundation Trust offers ongoing follow up support to those who they distribute a kit to or to those who contact them and are not in a position to financially follow up a positive screening kit result themselves. The charities screening page makes users aware that only a small percentage of those kits returned with a positive result will have bowel cancer as the majority of results indicate internal issues such as bleeding polyps, inflammatory bowel conditions such as Crohn's Disease, Ulcerative Colitis or Coeliac Disease or Haemorrhoids).
3. There is a risk that people with symptoms may be falsely reassured by a negative test result because not all cancers will be detected by a screening test. Repeated testing as part of a structured programme reduces this possibility there is the potential for the inequity of access to follow-on investigation for those with a positive result.
Bowel Cancer Foundation Trust advocates the annual use of the bowel screening kits to all those they have contact with which would ensure any false-negative results from previous kits would be counteracted with proceeding tests. Bowel Cancer is a slow forming cancer so regular screening should prevent cancer breaching the bowel wall if caught early enough and ensure the best possible outcome.
A final word from Georgina...
"The aim of screening is to find any polyps or to find cancer early when it is easier to treat and cure. We hope at the very least we can provide peace of mind and give the public a base in which to monitor their bowel health as they progress through life"