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Scottish Cancer Prevention Network | Putting Prevention First

Bowel Screening – The Q & A’s

The Scottish Bowel Screening Centre is based in Ninewells Hospital Dundee. So we took a little walk (200 steps to be precise) along the corridor to ask them about the sort of questions people ask about the screening process  and what we might be of interest to others.

Here are some the things that we never stopped to think about but others do ……

Q I have lost my kit/ dropped it down the toilet can I get another one?

A Yes – The Scottish Bowel Screening Helpline can issue a replacement kit. Call the Helpline (during office hours weekdays – see number below) to arrange to get a screening test.

Q I don’t have a GP but if I go and register with a GP Practice how long will it take for my kit to be sent to me?

A  You should have your kit within 5 days of your details being registered on the Community Health Index by your GP. If someone registers with a GP in an active board and is between the ages 50 – 74 they will be contacted quickly.

Q  I think I had a colonoscopy last year should I take part?

A Yes- it’s safer to take part as the test that you had may not have been a full colonoscopy or it may be that more than a year has passed since you had it. If your screening result is positive you will have a pre assessment with a health care professional who will look at your past medical history and consideration for a colonoscopy will be made at that point.

Q I saw blood in my sample but I have a negative result

A  Although you saw blood in your sample it was not enough for the result to be analytically positive for blood. Usually blood from a bowel cancer is digested in the bowel, blood that has been broken down. This blood is invisible. It would be unusual to see it with the naked eye. Blood streaked mucous and intact blood cells from anal bleeding would not produce a positive result. The laboratory have strict control procedures in places making the result very unlikely to be wrong. If you still have concerns you should discuss your symptoms with a GP

Q Am I more at risk because I have Inflammatory Bowel Disease / Crohn’s Disease / Ulcerative Colitis?

A In a population screening, people with blood in the stool are more likely to have bowel cancer than people who don’t. That is why we would encourage you to complete testing. If the result is positive for blood you will be referred for a further investigation, colonoscopy. Colonoscopy is the only way to find out if bowel cancer is the cause of the bleeding.

Q I am worried because I have some of the symptoms of bowel cancer that you describe in your information leaflet

A A number of common bowel conditions can have similar symptoms to bowel cancer. These include:  Haemorrhoids (piles), Anal Fissures (a tear in the lining of the back passage or the skin around it), polyps (‘wart’  like growths in the bowel), Irritable bowel syndrome, Diverticular Disease or Inflammatory Bowel Diseases such as Ulcerative colitis or Crohn’s disease.

For more information about Bowel screening in Scotland see https://www.nhsinform.scot/bowelscreening

The helpline for all queries is 0800 0121 833 (textphone 18001 0800 0121 833)

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A unique Birthday opportunity – Bowel Screening

Scotland has a unique bowel screening service offering a free test for adults aged 50 to 74 years. The screening test arrives through the post very soon after your 50th birthday and invitations to participate are offered every two years. The screening test may well be the only birthday card that can save a life.

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I have written about my own experience of bowel screening before (https://scpnblog.wordpress.com/2015/05/11/what-if/) and what I felt about a positive results but here are some of the queries that the Scottish Bowel Screening Centre deal with in relation to test results.

Q I feel well so I don’t need to do this test – there’s no family history of cancer, and I don’t have any symptoms……should I do the test ?

A The idea of screening is to pick up disease at an early stage before symptoms develop and when the chances of cure are more likely. We would encourage you to do the test…..

Q I have received my result letter which says no blood was found – does this mean I definitely don’t have Bowel Cancer?

A No the screening test is not 100% accurate because not all cancers bleed all of the time, and blood is what the screening test is looking for. Changes can also happen in between one screening test and the next, so it is important that you repeat the screening test every 2 years and never ignore symptoms.

Q What does a positive result mean?

A  This means that we have detected a significant amount of blood in your stool and would like to investigate this further. Blood in the stool can often be caused by a less serious problem e.g. haemorrhoids, fissures, inflammation of the bowel and bleeding gums. Another more serious reason is that early bowel cancer sometimes bleeds. The best way to find out the cause of your bleeding is to have a colonoscopy. An appointment will be made for you via your local health board, and with a specialist nurse who will explain the colonoscopy procedure.

Q What does a negative result mean?

A  This means that little or no blood was found in the samples on your test kit. You will be invited for screening again in 2 years time. “You should be aware that no screening test is 100% effective. It is therefore important that you are watchful for these symptoms: 

A change in bowel habits to;

  • Looser bowel motions (a change lasting for 4 weeks or longer),
  • Severe constipation ( a change lasting for 4 weeks or longer),
  • And/or needing to go to the toilet more than usual.
  • Severe Colicky abdominal pain.
  • Lasting unexplained tiredness or weight loss.
  • Repeated bleeding from the back passage.

If you notice any of these changes please contact your doctor as soon as possible. These changes should be taken seriously but are not always signs of bowel cancer.

Finally, a word from Professor Bob Steele programme director of the Bowel Screening Programme and co-director of SCPN

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“Please take the test even if you don’t have symptoms.  Indeed, if you do have symptoms you should pay a visit to your GP since the screening test is meant for people who don’t have any.  Your GP may then ask you to do a test that is similar to the screening test, but is designed specifically for people who have noticed something wrong with the way that their bowels are working. 

For more information about Bowel screening in Scotland see https://www.nhsinform.scot/bowelscreening

The helpline for all queries is 0800 0121 833 (textphone 18001 0800 0121 833)

 

Bowel Cancer… do you know the symptoms?

April is Bowel Cancer Awareness Month (BCAM), and this year Bowel Cancer UK and Beating Bowel Cancer is raising awareness of what symptoms to look out for, and the importance of acting on them as soon as possible.

In Scotland, almost 4,000 people will be diagnosed with bowel cancer and around 1,500 people will die from the disease this year, making it the country’s second biggest cancer killer.  However it shouldn’t be as it is treatable and curable, especially if diagnosed early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer but this drops significantly as the disease develops.

For BCAM, we commissioned a YouGov survey to gauge awareness of the symptoms of bowel cancer and the responses are alarming. From the 400 Scottish adults asked, over a quarter of them (29%) could only name one of the five most common bowel cancer symptoms and almost a third of people (31%) were not aware of any symptoms at all.

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We want to change this low level of knowledge in the country, and we are doing everything that we can to change this. This month our volunteers, most of whom have a personal experience of bowel cancer, are visiting community groups and workplaces across Scotland to deliver awareness talks. In addition to this, we took a giant inflatable bowel to Argyle Street in Glasgow on Saturday 7 April.  We used the inflatable bowel as an interactive way to demonstrate the different stages of bowel cancer and to give information on the symptoms of bowel cancer to a larger audience. During the course of the day we spoke to around 700 people. We were joined by six of our volunteers including Ron Kerr, who was diagnosed with stage one bowel cancer after visiting his GP with a change in bowel habits. He feels lucky that his cancer was caught early and became a volunteer to help us save lives.

Being aware of key symptoms and visiting your GP if things don’t feel right can help increase chances of an early diagnosis, andbowel cancer is treatable and curable, especially if diagnosed early. Bowel cancer screening is the best way to detect the disease at the earliest stage and the UK has a bowel cancer screening programme which is leading the way for the rest of the world. – .

The Scottish Bowel Screening Programme can detect bowel cancer at an early stage in people with no symptoms when it is easier to treat and a greater chance of survival. If you’re registered with a GP and aged 50-74, you will receive a test in the post every two years. You carry out the simple test at home in private and it comes with step by step instructions. The test looks for hidden blood in your poo, which could be an early sign of bowel cancer.

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Find out more how you can help raise awareness of the disease for Bowel Cancer Awareness Month here: bowelcanceruk.org.uk/bowel-cancer-awareness-month

  

Claire Donaghy, 

Head of Scotland Bowel Cancer UK and Beating Bowel Cancer

Scotland is now a FITter nation

In November 2017, a faecal immunochemical test for haemoglobin (FIT) was adopted as the first-line investigation in the Scottish Bowel Screening Programme. A number of our blogs have detailed the many advantages of FIT, including that the test is more specific for colorectal bleeding and is not subject to interference from dietary constituents. Importantly, only one small sample from a single bowel motion is needed.  This is obtained using a user-friendly specimen collection device. Because of this, more people invited for screening actually participate, including those in traditionally “hard to reach” groups.  The other three countries of the UK are also planning to introduce FIT as a first-line test in due course.

 

One of the benefits of FIT is that the threshold faecal haemoglobin concentration that is used to decide whether referral for colonoscopy is appropriate can be altered. The lower the threshold, the more colorectal disease is detected. We have shown that faecal haemoglobin depends on sex, age, deprivation and other factors, so there is a real possibility now to investigate whether factor partitioned thresholds would have value for participants. Further, faecal haemoglobin concentrations which are detectable, but below the threshold for referral, are directly related to future risk: other programme characteristics, such as screening interval or feedback information for the participant, could be based on the FIT result. Opportunities for improvement abound!

In addition, FIT is being rapidly rolled out for use in the assessment of patients presenting in primary care with symptoms of colorectal disease. This very different application could cut the number of inappropriate referrals for colonoscopy to secondary care, freeing up resources so that the threshold used in screening could be lowered and more early disease detected.

Professor Callum Fraser Senior Research Fellow, Centre for Research into Cancer Prevention and Screening, Honorary Professor, University of Dundee, Honorary Consultant Clinical Biochemist, NHS Tayside

Kitchen Table talks with SCPN

Following our recent blog on Help shape the future of food in Scotland inviting people  across  Scotland to get together for Kitchen Table Talks to discuss the future of food in Scotland the SCPN team and friends have done just that… and here is a glimpse of where our discussions took us..

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Dietary factors are causative in cancers of the mouth, pharynx and larynx, lung, stomach and bowel. Obesity is associated with 13 cancers including breast and bowel. The total cancer incidence is Scotland is predicted to increase significantly over the next two decades. A healthy, equitable food policy is essential for cancer risk reduction, improved well-being in people diagnosed with cancer and to optimise health care costs.

 

Many of the comments raised below have also been highlighted in our response to the Scottish government consultation (A Healthier Future – Action and Ambitions on Diet, Activity and Healthy Weight

Five Top concerns about Scottish food System….

  1. The availability, distribution, marketing and use of fresh produce – notably fruits and vegetables.
  2. Coupled with perceived (and actual) costs, motivation, time, skills and values that surround the use of fresh produce as a fundamental part of the Scottish diet.
  3. The unhelpfulness of the food industry in terms of nutrient composition and portion sizes for everyday basic foods.
  4. The inequity of food support for low income families and the challenges of how to address food poverty in a dignified and equitable manner.
  5. The challenge of nurturing our children to appreciate healthy basic foods, learn basic food skills and avoid the marketing challenges that food industry pose.
  6. Avoiding food waste – particularly for fresh produce.

Five Top actions for Government….

  1. Greater action to regulate the food industry re composition and portion size. Simply focusing on sugary drinks will not bring about equitable, relevant and population wide changes. In Scotland, sweetened drink consumption has been decreasing for years so current government action is yet another example of action on “low hanging fruit”. Action on salt has been successful but this has been taken across a broad range of food groups- the same is needed for added sugars, saturated fats and a re-balancing of the fibre (wholegrain) content of foodstuffs. In addition to salt targets here is a precedence for setting compositional targets from  the target nutrient specification set for school foods
  2. Fast food restaurants (FFR) continue to grow per head of population. It is timely for planners to consider whether all of these are necessary. In some locations these restaurants may provide the only “safe” venue for teenagers …. Surely we can do better than this?
  3. Identifying, testing and evaluation approaches to eliminating food poverty. The Healthy Start scheme has been demonstrated that food vouchers assist dietary change in one vulnerable group in society – is this an area for further exploration (certainly not a solo solution)? Whilst there is considerable support around food banks in many communities how might this support be better managed in a sustainable dignified fashion that allows equity of access to healthy fresh produce in adequate quantity and quality.
  4. Fostering a healthful food culture for our children. Supporting breast feeding initiation and maintenance, healthful weaning and the provision of school food of a high nutritional standard. Nutrient standards are important but only if these are regularly re-evaluated (e.g. taking new dietary fibre and sugar recommendations into account), monitored for implementation, audited and action taken where provision is sub-standard. In addition, there is need to think of “out of term time” support for healthy food support.
  5. A curriculum for life long food skills which give high importance to developing food skills (planning , shopping, budgeting cooking, minimising food waste) and appropriate hands on lessons for appropriate foods e.g. defining core skills (e.g. making soups, use of local produce, preparation of seasonal vegetables and basic ingredients (as opposed to cakes, confectionery, pastries should be developed and commended)). See here for further examples.

 

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Reader… you too can tell your thoughts and feed back to the Scottish Food Coalition– the form could not be easier!

This invitation is open for 10 weeks so action and feedback is requested by the 15th April 

Dance like nobody’s watching

 

#DanceBreaks

  •  Always good to get up from your desk and have a stretch, why not have a dance?
  •  Sharing spotify playlists is a great way to connect, if a good tune comes into my head phones that makes me want to move I’ll send it to my friends to inspire them!
  •  Dance breaks are especially good when you are working from home, no one is in and no one is watching, get up and put on a favourite track and have a good old dance, hairbrush karaoke permitted!
  •  I’ve got a big exercise ball at my desk now, great for dancing at your desk.. And I know others in the studio enjoy it to- I keep finding it on the other side of the room.
  •  If you need dance inspiration and feel like having a wiggle, you could always look to popular classics for inspiration.. Macerena, YMCA,
  •  Gifs
  •  If you’re feeling self conscious you could always try some voguing in the mirror 

 

Clubbing and self-conscious exercisers

Are you self-conscious about exercising in public? Think you’re too old to go clubbing? Well the latest craze to sweep the UK exercise world, Clubbercise, is just for you. Dancing in the dark with disco lights and lasers going, flashing rave glow sticks in hand, you can enjoy your favourite dance anthem from the 90s (and more recent ones) and really let go. Move to Oceanic’s Insanity, Berri’s Sunshine after the Rain or Eric Pryde’s classic Call on Me. The emphasis is very much on having fun but the serious stuff is that you’ll burn up to 600 calories in the hour, tone those muscles and have a really good cardio workout. Even your arms get a good work out waving those glow sticks!

 

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Launched in the UK in 2014, Clubbercise has become huge with around 80,000 people taking classes and more than 2,000 instructors across the UK, Europe, Asia and Australia. Both men and women take part in the classes, aged from 17 to 70. For those who are less able or easing themselves back in to exercise, there are always lower impact options and you are encouraged to take it to your level and enjoy the music.

Find out where your nearest class is at https://www.clubbercise.com/find-a-class

A little boogy goes a long way

There’s still four days until payday and my, has it been a long month. We’re just about coping with Dry January (but only because we can’t afford booze anyway), feeling sluggish and it’s raining cats and dogs outside. My desperate disco playlist sounds quietly in the background, fighting against the much louder, more aggressive winter storm, as we attempt a tediously slow game of Scrabble in our cramped North London studio flat.

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I give up all hope and start melting into my chair as he lays down his second six-letter word across a triple (“Only 81 points” he mutters), when I hear Chic’s crowd-pleasing, game-changing words across the room,
Any time, any place,
Dancing helps relieve the pain.
Soothes your mind, makes you happy again.
Listen to those dancing feet!
Close your eyes and let go!”.
The perfect excuse to end a game I’d lost a long time ago (as with every game of Scrabble I play)! I reach across to the speaker, turn the volume up and begin furiously throwing shapes across the room as Chic chants what we all want to hear: “Everybody dance!”.  He’s forgotten about his score already! He’s on the dancefloor with me, and we’re doing box steps and twirls in unison. After a few repeats of the tune, we’ve mastered a pretty solid routine.

We film it, share it and propose a dance off.

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A little boogy goes a long way. We challenge you to try it.

 

 

 

Ob_s__y is a cause of cancer… communications

Let us be clear excess body weight is associated with 13 cancers including breast, bowel and kidney (link). And this message needs to be communicated because we know that public awareness of the risk of overweight and obesity are low (link).

Well, CRUK has certainly stirred up a hornet’s nest with their poster campaign on calling Obesity a cause of cancer. How uncomfortable for us all … given we are so used to posters of happy children eating junk food, big burger smiles, strong girder drinks and smiling supplement users.

Strong, and blunt messages about cancer just aren’t part of our warm and safe marketing landscape. The objections came fast and furious and even from unexpected quarters…. the comedian bellowing loud about ‘fat shaming’ all over twitter and echoed by the BBC, the Guardian journalist Christina Patterson (book due out soon) about the importance of state of mind versus science and risk and Margaret McCartney in the BMJ who flags how people with cancer have felt blamed and the potential harms caused by this campaign.

So four issues come to mind:

  1. Would CRUK have been wiser to use a more visual scientific image with some key mechanisms flagged. The Cancer Council WA used very large and very memorable posters that got right to the meat of the matter (see “grabbale gut” image below). In addition, our work from talking to women and alcohol gained credibility when some insight is given to the scientific mechanisms.
  2. What short memories we have. All those vivid posters about the harms of smoking were so clear (see images below). Collectively we all know smoking is bad health news….and the aim of those campaigns was never to outlaw smokers or create guilt but raise awareness and they succeeded!
  3. Thinking positively… there is increasing evidence that decreasing excess weight can REDUCE risk of cancer. What we desperately need now are environments that support and help us to be active and market healthy foods and healthy portions.
  4. Finally, the health risks associated with obesity are too big to ignore. There is a duty of care to communicate what the experts have identified to the public. We do not a believe in keeping science secrets- but we need to shame the causes of obesity not the people who suffer.

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Professor Annie S. Anderson

Professor Bob Steele

 

 

Men dance too… (at any age)

Far too little is written about men’s health and cancer prevention on our blogs- but that is about to change! Higher levels of physical activity reduce the risks of several chronic diseases including bowel cancer as well as obesity related cancers.

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Being active in everyday life is our motto- whether dog walking, stair climbing, cycling or other pursuits.   This month we are highlighting the theme #justDANCE as an easy indoor/outdoor way to be physically active. No sport, just movement (preferably with music) – alone or in company, structured or free form and possible at any age from tots to the tottering.

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Dance is for boys and men too – something often forgotten. We all know about Billy Elliot but, back in the early 90’s when my son ( from the ages of 5 to 13) was a competitive highland dancer this pursuit was definitely considered more than a little odd by his rugby playing mates. At 30+ he still dances and in fact reels very well but what about older men? Lots of opportunities for gym sessions and walking football but dancing?

I recommend an excellent website on older men dancing (http://www.dancingman.co/) written by Damain Killen – a 72 year old male dancer/mover. He writes that for seven years he has attended dance classes and performed  as a  member of a semi-professional dance company and notes that he is usually the only male in the class and was the  only male member of the company. He aims to encourage more older men to take up the  opportunities that exist to develop and to perform and to express themselves through dance. He reminds us that this is something that has happened throughout history and it happens now around the world in different cultures. What is that stops men from dancing  and what can be done about it?

Damian is keen to hear from older men who are dancing, particularly if those involved in contemporary dance and performance anywhere in the world and from any dance projects that are targeted at men. What can we learn from each other about making dance attractive and satisfying for men?

Well here are some comments from our SCPN country dancing friends (all male, all over 60 ++)  and we welcome any comments from men participating in other dance forms…… #justDANCE

“Of course men dance too because it’s a great physical and mental work out – far more enjoyable than the gym.

At the same time you meet loads of sociable, friendly people and have lots of fun – the best you can have with your clothes on!

Plus, men are often in short supply so they usually receive a warm welcome from the ladies …..”

At 70, Hip-hop, Gangnam or Break Dancing is now a generation or two way out of my league!  However, Scottish Country Dancing is well within, not only giving my body gentle exercise but if a courtly Strathspey then it’s a very genteel workout.  Not only am I exercising those increasingly creaky limbs I’m exercising the mind by trying to remember some quite often intricate and convoluted routines.  As Poirot would say “keeping those little grey cells working”.  Now just because I’m writing about the virtues of Scottish Country Dancing, don’t for one moment think I might be some twinkle-toed aficionado………..that I am most definitely not!  I often refer to myself as the ‘Dunce of Dancing’ and I have been observed to be like a rabbit caught in the headlights!  I don’t (can’t) do the fancy light footed steps of SCD, achievement for me is defined as getting through a dance ‘route’ without going too wrong but importantly not sending everyone else wrong!  Hey, I’m a man whose dance repertoire consisted of  ‘Dad Dancing’ to 60’s favourites, Scottish Country Dancing is relatively new to me

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All my life I have enjoyed dancing, the only trouble was I was never any good at it.  As I got older some of my innate shyness slowly disappeared and I did not have to spend ages summoning up the courage to ask a pretty girl for a dance.  However I was still hampered by not being able to find a form of dancing which suited me.  I needed something reasonably complex, to keep my ageing brain active, physically demanding (but not too demanding) to keep myself fit and my joints supple, and something where the finer points of grace and elegance were not of primary importance.

And then I discovered Scottish Country Dancing.  Now if you are a pro, and belong to the ‘Royal Scottish Country Dancing Association’, then grace and elegance are of prime importance.  But to us lesser mortals the key is just trying to be in the right place at the right time.  To do this you need to be able to think on your feet and be physically agile.  In addition, this type of dancing lends its self very well to socialising and making new friends.  So what could be better for the man who used embarrass his kids by ‘dad dancing’ and any potential partners by treading on their feet. So if you want to keep fit and active, physically and mentally, just get out there and dance. 

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Dancing was never very important to me until I left my native Scotland and settled in Nottingham in 1990 where  I joined a Scottish Country Dancing group and discovered a whole new world that has held me ever since. It’s difficult to define what it is about dancing, and Scottish Country Dancing in particular, that is so captivating, but I suppose it is a combination of movement, grace, team working, companionship and plain good fun.  It also has the advantage of not requiring a high level of skill to participate fully, but at the same time it leaves infinite room for improvement. In other words, anyone can quickly find their own level and derive enjoyment and sense of achievement from being part of a dance group.   

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Being a dancer can be a bit like being an addicted runner – the “highs” you get from dancing make you keep wanting to come back for more, and the sense of well-being combined with increased fitness make dancing an intensely satisfying pursuit.  It also makes you acutely aware of the level of skill displayed by professional dancers, and since becoming a (very) amateur dancer I have developed a keen interest in ballet and modern dance. So, although I could never aspire to the dizzy heights of professional dance, I find it really inspirational and yet another world has been opened up to me which I would strongly recommend to anyone who enjoys dancing at any level.

In other words #justDANCE

 

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