AM I AT RISK?

Cancer of the large bowel is the most common internal cancer in Australia and develops in 1 in 20 Australians. The risk begins at age 40 and increases with age. If detected early, bowel cancer is curable.

POLYPS

Polyps are growths that can occur on the lining of the bowel. Most bowel polyps are not cancerous but nearly all bowel cancers start as polyps. They may bleed, and occasionally cause diarrhoea or pain. Because any bowel polyp can develop into cancer, all bowel polyps should be removed.

HIGHER RISK

Your risk of bowel cancer increases 2 to 3 times the average if:

• You have had one or more close relatives (mother, father, brother, sister or child) who have had large bowel cancer or polyps.
• You have already had bowel cancer or polyps.
• You have had extensive inflammatory bowel disease (Crohn's disease or ulcerative colitis) for more than 8 years.

RISK DUE TO YOUR AGE

Age is an important risk factor - 80% of bowel cancer occurs in individuals in whom the only risk factor is their age. The BCPP recommends the most effective test in finding and removing polyps is a Colonoscopy beginning at age 50. Please discuss with your Family Doctor how you may enter a colonoscopy surveillance program.

Many bowel cancers occur in those without any high risk factors. With polyps or early cancer, there may be no symptoms. However, there may be a small amount of bleeding which is not easily visible but can be detected with chemical tests of bowel motions (FOBT – Faecal Occult Blood Test). You can ask your Family Doctor about this test. This test is not suitable protection if you are in a high risk group or have any symptoms. Furthermore, this test is directed at early detection rather than prevention. Not all cancers and polyps bleed and a negative test does not necessarily exclude polyps or bowel cancer. A positive test must be followed by a colonoscopy.

DANGER SIGNALS

• Bowel cancer may be present without any symptoms.
• Bleeding from the bowel (always look in the toilet bowl) - see your doctor without delay.
• Persistent change in bowel habits - diarrhoea, constipation or abdominal pain (NB: these symptoms may also have other causes, but should always be investigated.)

ACTION

• If you are in a High Risk group, you should have a colonoscopy once you reach the age of 40 or earlier if you have symptoms or your relative developed bowel cancer at an early age.
• If you have any bleeding from the bowel, consult your doctor. Such bleeding always needs investigation.
• If you are over 50, your doctor may discuss with you the value of entering a colonoscopy surveillance program or of an annual test for hidden blood.

LIFESTYLE

A high fat diet and a high consumption of alcohol may be related to bowel cancer. Eating fibre-rich foods may give some protection. The Australian diet is one of the fattiest diets in the world and most people do not eat enough dietary fibre. To minimise the risk of bowel cancer, you should:

• Eat less fat.
• Drink less alcohol.
• Eat more high fibre foods such as wholegrain breads and cereals, fruits, vegetables and legumes.

Other important factors may include smoking, obesity and diabetes.

TESTS

FOBT
This test looks for hidden blood in the stool. A positive test must be followed by a colonoscopy. Many cancers or polyps do not bleed so a negative FOBT does not exclude polyps or bowel cancer. International studies have shown community FOBT reduces mortality from bowel cancer by around 15-30%.

Colonoscopy
Most polyps can be found and removed in one procedure by an instrument called a colonoscope. This is a flexible illuminated tube that looks at the inside of the bowel. It is a safe procedure, performed as a day admission (no need for an overnight hospital stay) and you will be sedated to avoid any discomfort.

International studies have shown that a colonoscopy surveillance program directed at the general community reduces bowel cancer mortality by 70-90%.