As a child, I was always considered nosey – asking big questions, little questions and all sort of questions that annoy adults. Some of my family just avoided me, but some liked to be asked things and had tales to tell. One night, my aunt decided to indulge me, and responded well to being asked about my grandmother. She told lots of stories about her work, how she coped with hardship on the farm, her baking, her favourite things and then how she died. Forty odd years on I don’t remember many of the details, but I do remember the nightmares I had when I thought about the details of how bowel cancer had killed her, and desperately wishing I hadn’t asked.
The years rolled by, and I guess my inquisitive nature helped me whizz through studies and into my research career. I didn’t give much more thought to bowel cancer again, until I started doing family history with my father. He held so much in his memory about who married who, cousins, speculations on fatherhood, and some cracking tales of big families. He also reported in on causes of death, and more bowel cancer came flowing out of the closet – just enough to make me wonder about my risk. One dead cousin and two aunts later, it seemed to me I better get my lifestyle ship shape and try to prevent the disease.
I enjoy my sense of control over health. I chose my diet carefully, I finally got into exercise and I even moderated my alcohol and meat intake (no sausage will ever pass my lips!). I changed my research focus to lifestyle and cancer prevention, and I have received significant funding from the Medical Research Council to test a lifestyle intervention programme in people at increased risk for colorectal cancer. I helped to set up a research group on cancer prevention and screening (CRiPS), and through the SCPN, advocate the bowel screening programme for Scotland which is offered free of charge to everyone over 50.
My 50th birthday was marked by a surprise family party with lots of celebrations and cards. One of the cards was my bowel screening kit and it was naturally assumed by the medics in the household I’d get the samples off before the week was out because I’d like to know to about these things!
But the weeks passed, and the card sat on my dressing table, because I was not ready to be diagnosed, I did not want a cancer to impact on the family wedding, the graduation, the last set of school exams, my work and my relationships. I was not prepared to make the time to be operated, treated or spoken to in a sympathetic manner. A few months later, my nearest and dearest spotted the unopened test and said I’d be letting the side down if I didn’t return it, and so rather reluctantly, I did the needy and sent it off. The results were positive and the repeat results were too.
The range of emotions roller-coasted from anger that I’d done the test, fear that it would be something inoperable and death was inevitable, embarrassment that after all this lifestyle work I would look stupid and people would tell me about fate and worst of all, I’d be treated by my work colleagues. Of course my clinical colleagues were the ones who reassured me that my family history was not in fact very strong, a positive test did not equate to a diagnosis, that the colonoscopy was very straightforward, and actually they could fit me to any cancellation slot in the next week. I wanted to delay the colonoscopy as long as I could, just to savour life as it is – which felt to me like something to be enjoyed and lived to the full. I still had a choice – I didn’t need to be diagnosed – I had the power to delay it all.
I could tell my husband was anxious and had seen too many cancers to sleep easy. I didn’t want to talk about it, but then I decided to open the door and ask, and ask about every thing. What did you wear when you have the procedure, who is in the room, do you go on a trolley, what if something is found, what are the treatment scenarios? In the end I rationalised it – I was under the care of one of the best UK centres for colorectal cancer, early detection means limiting the chance of the disease spreading and actually we can cure the disease if we get it early.
I didn’t have a bowel cancer, but I did have an adenoma, which was removed easily and painlessly during the colonoscopy procedure. Yes, I am now considered at moderately high risk of getting the disease, but that tumour pre cursor has gone, and isn’t going to grow into a full blown cancer. I will be seen regularly in case any more show, and I am in an excellent healthcare system, and I am grateful for the opportunity that my grandmother, aunts and cousin never had.
This year, several years on, I had my colonoscopy repeated and got an all clear, but it made me stop and think. What if I hadn’t returned that first test? How far would that adenoma have grown? What if, this year, I had got a diagnosis of cancer, and could not play with my grandson, or travel, or teach, or run my research group? There is no good time for a diagnosis, but every time is a good time to return the screening kits and enjoy life without regrets.
Professor Annie S Anderson BSc PhD RD FRCP (Edin)
Anderson AS, Craigie A, Caswell S, Treweek S, Stead M, Macleod M, Daly F, Belch J, Rodger J, Kirk A, Ludbrook A, Rauchhaus P, Norwood P, Thompson J, Wardle J, Steele RJC (2014) The impact of a body weight and Physical Activity weight loss intervention (BeWEL) initiated through a national colorectal cancer screening programme. BMJ;348:g1823.