The Daily Telegraph - Features
The Surgery
The age limit on cancer screenings makes sense
The rationale of screening programmes for early detection of cancer is obvious, and for breast cancer in particular, more than vindicated: over the past 40 years, regular checks with mammography along with improvements in treatment have resulted in a spectacular decline, by almost half, in the numbers succumbing to the illness. The merits of screening tests for cancers of the bowel, prostate and cervix may not be as dramatic but it seems sensible to take advantage of the opportunity when offered.
But there is an anomalous situation here. Cancer is an age-determined disease – the older you are, the greater the likelihood. Why then do screening programmes impose an upper age limit of those deemed eligible (71 for breast cancer, 75 for bowel cancer, and so on) thus excluding those at highest risk?
The motive behind this apparent discrimination one might suspect is financial – a way of saving the NHS money. But screening in the older age group is not necessarily advantageous. First, its potential harms are more serious. For every 1,000 women over the age of 70 early detection with mammography will prevent two dying from breast cancer. However, 13 would be “over-diagnosed”, thereby exposed – to no purpose – to the hazards of treatment (surgery, chemo and radiotherapy), as their cancer would never have spread or caused any problems. When diagnosed early, it’s impossible to tell these harmless cancers apart from the harmful ones. Then there is the tricky issue of life expectancy. A healthy 75-year-old woman found to have early-stage bowel cancer and treated appropriately could expect to live on for another 15 years (at least). Here, screening is clearly worthwhile, but not so were she to have some serious medical condition limiting her life expectancy to just five years.
Cancer screening for those aged 70 and over, balancing benefits against risks, is not straightforward. So what to do? To its credit, the NHS has settled on a reasonable compromise of imposing an age limit to minimise the dangers of over-diagnosis and unnecessary treatment while allowing those motivated to do so to request screening on an individual basis. The absence of “facilities” on the newly opened, 73-mile-long Elizabeth line has prompted much comment in this paper, not least the serious inconvenience for those afflicted with chronic bowel problems, notably the diarrhoeapredominant form of irritable bowel syndrome.
Gratifyingly, this may be less of an issue than in the past with the recognition that there are several causes of this variant of IBS, each warranting its own treatment. For some, their diarrhoea is due to an excess of the bile acids secreted by the gallbladder that irritate the lining of the gut – curable with the drug colestyramine. For others the problem is hyper-motility – overly frequent and rapid contractions of the muscles in the wall of the colon. This can be alleviated, as recently reported, by a small dose of amitriptyline that blocks the action of the neurotransmitter acetylcholine, thus slowing the contractions.
In some people there may also be a psychogenic component, particularly anxiety, which can precipitate a bout of diarrhoea. “I can’t recall how many times, when out shopping, I have had to abandon my trolley and rush to the toilet,” writes one woman, every aspect of whose life – driving, visiting restaurants, playing golf – was vitiated by her IBS. Aged 65, she planned to go on a celebratory safari with her family and resolved to prepare herself with an intense programme of anxiety-mitigating measures – hypnotherapy, listening to calming tapes and sessions with a reflexologist. Since then, her days of dashing to the lavatory are over. “It has been life changing,” she reports.
The NHS has a cut-off to minimise the dangers of over-diagnosis and unnecessary treatment
No ‘facilities’ on new Tube line needn’t worry IBS sufferers