Bowel cancer: is self-funded screening a good option?

Antony Bax went to the GP a few years ago, worried about a change in his bowel habits. He hit roadblocks when it came to being referred or screened. Frustrated, he purchased a self-screening test.

But what do you do if you’re worried and under that age?

Bowel Cancer NZ’s chief executive Peter Huskinson says under a new initiative rolled out this year, Bax would have been given a screening kit.

The change means anyone with symptoms can go to the GP and be offered a FIT (Faecal Immunochemical Test) test, which measures the amount of blood in stools. This is the same test used in the government's free screening programme.

But there is another option – self-funded screening.

This is a good option for people over 40 without symptoms who have the money to pay for it, says Huskinson.

There are two types of self-screening tests - a FIT test or a Colotech, which looks at DNA changes – available for purchase from three private companies. Prices range from $144 to $265. These options are linked on Bowel Cancer NZ’s website.

But are they any good?

Huskinson says these three options are an effective prevention tool because the government’s screening programme does not cover younger people.

“By international standards, we screen people very late for bowel cancer.

“That's one of the reasons we have high death rates and our rates of bowel cancer are higher than they could be.

“In many countries around the world, they're screening now at 45 and even at 40, which means that we have a much better chance of people catching cancer before it develops.”

Huskinson says you’re four times more likely to be diagnosed with a 90 percent curable stage one cancer from a screening, rather than waiting for symptoms to develop.

“So really, really good for prevention, really, really good for early detection and therefore really, really good for survival.”

What do you do if you get a positive result from a self-funded test?

The first thing to do is go to your GP, but from there your public health pathways might be limited.

“If you did get a positive self-funded test, it doesn't necessarily guarantee that the government will then cover the cost of the colonoscopy,” Huskinson says.

People wanting further tests might have to pay for private treatment.

Does a positive test mean you have bowel cancer?

Not necessarily, Huskinson says.

“For every cancer that is picked up, around 10 people will have a pre-cancerous polyps picked up... not all of those will turn into cancer, but as part of the follow up... if you have the colonoscopy they can remove those precancerous polyps so then they’re not going to turn into a cancer.”

Dr Jo Scott-Jones, a GP and clinical director of primary health organisation Pinnacle, says there are many other reasons that aren’t cancer that could return a positive test.

Haemorrhoids, anal fissures and inflammatory bowel disease can be common causes of blood in the stool.

What can you do instead of a self-funded test?

Dr Scott-Jones doesn’t think anyone should pay for self-screening and suggests that talking to a GP first is the best thing to do.

“If people have symptoms, then they need to talk to their GP and explore those symptoms.

“If you have a strong family history of bowel cancer, talk to your GP about it and they will organise the appropriate screening, which would usually be a colonoscopy on a regular basis, rather than purchased FIT tests, which will just likely to just confuse things.”

He says that if people don’t have any symptoms, then it’s sensible to wait for free government screening at age 58.

Dr Scott-Jones strongly advocates for free screening to start at age 50, but New Zealand doesn’t have the capacity or system to provide the free follow-up care yet.

“If you're doing a test outside of the screening age, you're very likely to be advised the solution for whatever it is that's going on, or if you want to explore it further, is a private colonoscopy.

“And you're going to feel quite frustrated if you can't afford that.”

Bax was able to go through the private system after his positive result.

He had tried to get help from his GP after noting a change in his bowel habits but was unable to.

“The issue wasn't the GP itself. It was beyond that getting the actual access that was the issue.”

His wife found the True Proactive Health fit tests online and bought him one. It came back positive.

From there he went to a private specialist and then had a colonoscopy.

During the procedure, doctors removed a 4.5cm polyp for testing. While it tested negative for cancer, the doctor told him the polyp had pre-cancerous visual markers.

"And due to the nature of the shape and size of it, he said 100 percent would have been cancerous within the next two to three years.

“He said you definitely did the right thing. It saved your life getting it removed.”

Dr Clive Price from private FIT test company True Proactive Health did yearly screening tests before he moved from the UK.

Unable to find them here, he started his own company.

True Proactive Health is one of the two FIT test options in NZ, but Dr Price is the point of difference. As a GP he reads all the lab results and communicates directly with those who have positive tests.

It also uses a lower threshold for blood in the stool, this means it picks up more, but has a slightly higher chance of a false positive.

Since March they have sold nearly 3000 tests and got 30 positive results.

“Only two of those colonoscopies have had zero findings at all. Most of them have had multiple polyps, which can bleed and given enough time, they can turn into bowel cancers.

“We've probably had kind of significant findings or essentially potential life-saving findings in about 50 percent of our positive tests.”

He said they are only targeting the 45-plus range who might benefit from screening.

“One of my big concerns would be that maybe offering wider access to tests would increase the burden on the health system, but our initial results have not supported that.

“Out of essentially about 30 positives, most of those have accessed private investigations.”

Dr Price says the next step is to come up with a way to get access to people from high-risk groups who can’t afford it.

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