As soon as he became eligible several years ago, Dubliner Eamonn Murdock took part in the bowel screening programme.
Each time, he took his own stool sample before posting back the tube to the health officials. And each time, the results would be sent back to him.
“They were always negative – always,” the 70-year-old says.
Last year, however, was different. He left the at-home testing kit sitting on his mantlepiece gathering dust until his wife reminded him to use it. He sent off a sample.
RM Block
“I fully expected it to be negative but it came back positive after further investigation,” he says.
Murdock was diagnosed with bowel cancer – stage three, when the tumour has spread to lymph nodes or nearby organs – though he is grateful that he was on the “milder side” of stage three. He underwent surgery and chemotherapy, having had his final session in January.
“Screening definitely saved my life. I think people are squeamish, but you shouldn’t be. A few seconds [for the test] could be the difference between life and death,” he says.
In Ireland, people aged 57-71 are invited for screening every two years, though it is planned to extend eligibility to those aged 55-74 years.
The restricted access is facing scrutiny due to the rapid rise of bowel-cancer diagnoses among younger people.
For the first time in history, younger adults are seeing cancer rates climb faster than older adults. In the US, colon cancer is the leading cause of cancer-related death for men and women under 50.
People born in 1990 are twice as likely to get this form of cancer as those born in 1950.
In Ireland it is the second most common cancer in men and the third most common in women.
According to National Cancer Registry Ireland, bowel cancer among under-50s has almost doubled over the past 25 years. One in 10 bowel cancer diagnoses in Ireland now occurs in someone under 50.
There has also been a 75 per cent increase in the incidence of bowel cancer among people aged 20-35.
This came into sharp public focus this week following the untimely death of 34-year-old elite athlete Ciara Mageean. The Co Down woman died 18 months after being diagnosed with stage-four bowel cancer – generally when the disease has spread from its original site to other parts of the body.
The reasons behind the rise in cases are still unclear, though there are believed to be many.
[ Cancer rates rising more quickly among younger people, international study findsOpens in new window ]
A variety of studies have linked the increase to ultra-processed foods, sedentary lifestyles, increased obesity rates, gut microbiome diversity changes (shifts in the microorganisms in the digestive tract) and environmental exposures, including viruses and pollution.
Risk factors for bowel cancer include increasing age, being male, a family or personal history of bowel cancer, personal history of inflammatory bowel disease, sedentary lifestyle, obesity, a diet high in red and processed meats, smoking and alcohol consumption.
Prof Maeve Lowery, consultant medical oncologist and academic director for the Trinity St James’s Cancer Institute, says identifying the reason for the uplift was a “burning question” among researchers.
“When you look at these figures, everyone cites rising obesity, alcohol, diet,” she says. “But Ciara is an exemplar of how young healthy people can still get these cancers. Some patients don’t have these factors.”
Lowery says one avenue being explored is if there is a pattern of something happening in early childhood, such as exposure to e-coli, which early evidence suggests could lead to cancer later in life.
“They’re hypotheses but it’s very unclear. It’s a big focus of research across the world,” she says. “Looking at microbiome – studying what bacteria are living in the gut – can sometimes be a clue.”
Brendan Donlon, executive chairman of Bowel Cancer Ireland, says although there are few answers to what is causing the rise in incidence among younger people, there is a clear need to reduce the screening age further.
“We have to focus every bit of resources on dealing with how to screen more people, and to have resources in place,” he says.
“We have made progress, having moved it down to 57. But we’re still nowhere near where it needs to be. The global standard is 50 at a minimum, and 45 is ideal.”
He adds that it is “one of the few screening tools that actually screens but also removes precancerous cells before they become cancerous”.
The State’s health services watchdog, the Health Information and Quality Authority (Hiqa), in April published a health technology assessment on extending the programme.
It says there are “clear benefits” to expanding the programme to those aged 50-54, but there are also “capacity issues”.
“By lowering the age, the population eligible for screening would be increased by 27 per cent,” says Dr Máirín Ryan of Hiqa. “Therefore we advised that an extension of the BowelScreen programme to those aged 50-54 must be done in a way that does not negatively impact the current screening programme or the wider symptomatic services.
“This would require a phased approach to implementation, and significant forward planning and investment in staffing and training to ensure sufficient resources are in place for the extension of screening to those aged 50-54.”
But even if the programme is extended to 50, that would still result in people who are diagnosed when they are younger falling outside of eligibility.
Lowery says there’s a “whole swathe of people in their 30s and early 40s who wouldn’t be caught in that”.
“But there’s no sufficient evidence to support extending screening to that age group. You could maybe look at high-risk screening, but beyond that, there’s no good evidence.”
She believes to ensure identification of early-onset cancer there is a need for “symptom awareness among adults and healthcare practitioners – making awareness better to make it really clear. If you look at breast cancer, they have done a really good job at getting that message across to check yourself.
“I’m not sure everyone knows the signs of bowel cancers or other gastrointestinal cancers. We need to change that narrative around it.”
Brendan Donlon agrees. He says there are a number of key symptoms people should look out for.
“A real red flag is blood in your poop; if your toilet bowl looks very red or black, that’s an urgent flag,” he says. “Do not wait. Go and contact your GP.
“Each of us has to be aware of what normal bowel movements are for us. You have to know your own normal – frequency, size, colour, consistency – to be aware when it’s changed dramatically and it stays changed.”
He says some symptoms such as persistent tiredness, weight loss, pain or bloating could appear innocuous or be caused by a whole host of other conditions.
“But you don’t need to have all of them. Any one of them needs a trip to the GP. If you’re a young person, especially if you’re a young woman, you will need to do advocacy work on your behalf because there are so many benign reasons. You’re just trying to rule out bowel cancer,” he says.
“By the time you have a symptom you can’t ignore, it is an advanced cancer. Therefore it’s only speed and luck if you can get it diagnosed quickly.”
