| Under the microscope: |
| Screening men for bowel cancer up to fifteen years earlier may help save lives, a recent study has shown. Austrian scientists studied nearly 45,000 people and concluded being male is a significant risk factor in the development of bowel cancer. They suggest screening men from the age of 45 years could avoid early abnormalities being missed. |
| The study followed participants aged between 50 and 79 years old who were screened over a period of four years as part of the national screening colonoscopy programme in Austria. The results of the colonoscopies, including laboratory tests, video and photo documentation, were reviewed for signs of adenoma, advanced adenoma and colorectal cancer (bowel cancer). The results showed the prevalence of adenoma, advanced adenoma and bowel cancer was significantly higher in men than in women of comparable age; 24.9% of men compared to 14.8% of women. |
| In the UK, screening does not take place until men and women reach age 60. In Scotland screening takes place from 50 years old and the Beating Bowel Cancer campaign advocates lowering the age limit to 50 years of age across the entire UK. |
| "It is worth it to get a screening colonoscopy early enough - at 50 years old if you are a woman and, if it's possible, at 45 years old if you are a man - since 35% of healthy, asymptomatic individuals have polyps and 20% of all those have adenomas, which are really easy to remove before they develop into colorectal cancer," said study author Dr. Monika Ferlitsch, an associate professor of medicine at the Medical University of Vienna in Austria. |
| On the case: |
| Lisa is a 27-year-old woman who attended the surgery for a routine pill check. During the consultation you notice she has not participated in the cervical screening programme. You offer to take a sample but Lisa is very reluctant to have this done. |
| What underlying causes could be preventing Lisa from participating in cervical screening and how can you go about persuading her to take advantage of the programme? |
| Many factors influence participation in the cervical screening. Statistically women in the 25-30 age range are less likely to take advantage of cervical screening than older women. Factors that may influence this are fear, misinformation, myths, misconceptions about risk factors, previous sexual assault or abuse and psychosexual issues including body dysmorphia. |
| Time needs to be taken to explain to Lisa the cause of cervical cancer and the relationship of the human papillioma virus (HPV) to cervical cancer. Risk factors such as smoking and immune system problems such as human immune deficiency virus should also be discussed. |
| Lisa is now better informed but says she would prefer to have the HPV vaccination than cervical screening. |
| How should you respond? |
| Firstly, always see if the client is sexually active and do not assume this even if they are using contraception, they may be using the combined pill to regulate their periods. |
| There are two HPV vaccines; Gardasil which immunises against HPV 6, 11, 16 and 18 and Cervarix which immunises against HPV 16 and 18. Cervarix is the vaccine used in the national immunisation programme for girls up to age 18. Lisa is outside the age range for the HPV vaccination programme and therefore would not be eligible for vaccination on the NHS and would need to be immunised privately. If Lisa has been sexually active she may have already come into contact with any of the HPV strains as above and the vaccination prevents but does not ‘cure’. |
| In brief… |
- PDUK’s Cancer Screening Update course will keep you abreast of current thinking and help to offer a better patient service. For further details, click here
- Would you like further information on running an In House course in your area? For further details, click here.
- Still waiting for our latest brochure? Click here.
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| Ask PDUK |
| Liz Sherlock ANP answers your questions below… |
| A 20 year old attended the surgery requesting cervical screening as she was concerned. We don’t do cervical screening until age 25 and so the receptionist sent her away. Was this right? |
| No. She should have been advised cervical screening is not routinely done at her age but that she should still talk to a clinician who could explain the cervical screening process and assess her risk factors for cervical cancer. Also, it is important to find out why she was concerned and did she have any symptoms such as post coital bleeding which would need investigation? |
| One of my patients is age 70 and heard he should have received a bowel screening kit as this type of screening is offered to people up to the age of 74. Why hasn’t he received a kit? |
| The extension of the age range for bowel cancer screening from 60-69 to 60-74 will be completed by 2014. Anyone over the age of 70 who wishes to be screened sooner should telephone the free helpline on 0800 707 60 60. |
| One of my patients has breast implants, can she be screened? |
| Yes she can but she should be advised to contact the breast screening unit who invited her so she can be offered an appointment at the main unit not a mobile unit. This is so more time can be allocated and the mammogram can be checked to ensure the implants are not obscuring the view of the breast tissue. |
