Nursing

Bowel Cancer

Discuss the impact bowel cancer screening has had on the detection of bowel cancer.

Screening for bowel cancer consists of testing in people who do not have any clear symptoms of the disease. The intention is to find any polyps, or trace of cancer early when it is easier to cure with treatment. It is possible for bowel cancer to develop without any early warning signs, which is why screening is so very important. The cancer can develop on the inside wall of the bowel and remain there for a number of years before spreading to other parts of the body. There is often very small amounts of blood that escape from these growths and pass into the bowel motion before any symptoms are noticed. There is a test called a Faecal Occult Blood Test (FOBT) that is used to identify these small amounts of blood in the bowel motion. The FOBT looks for blood in the bowel motion, but not for bowel cancer itself, as it is merely just a screening. Screening for bowel cancer using a FOBT is a very simple non-invasive process that can be done in the privacy of ones own home. Although there is no screening test that is 100% accurate, the FOBT is currently the most well researched screening test for bowel cancer. By having an FOBT every two years, a person can reduce the risk of dying from bowel cancer by up to one third. People who have symptoms of bowel cancer or who have a family history of bowel cancer should consult a doctor as soon as possible. Bowel cancer can be successfully treated if it is detected in its early stages. Unfortunately fewer than 40% of bowel cancers are detected early. Research has found that population screening for bowel cancer can reduce deaths caused from bowel cancer by 15-33% (Australia National Bowel Cancer Screening Program, 2009).

Differentiate between prevention initiatives; population-based screening and diagnostic testing.

Prevention initiatives are undertaken in order to reduce the number of deaths that can occur from bowel cancer. The idea of using population screening is to be able to increase the incidents of bowel cancer that are detected early. If something is detected by the initial screening process then a person would be referred for diagnostic testing in order to further determine what is going on. It is from the diagnostic testing that a true diagnosis can be made. If bowel cancer is indeed detected then treatment will then commence.

The plan of screening is to discover early whether cancer is present. It is at this point that it is easier to treat and cure. Habitual screening is imperative since bowel cancer can develop without any early warning signs. Screening tests are used to help avoid bowel cancer deaths by finding polyps and cancers early, which is when treatment works best. Presently less than 40 per cent of bowel cancers in Australia are detected in an early stage. Regular screening, using a FOBT is thought to reduce the number of Australians who die each year from bowel cancer (Australia National Bowel Cancer Screening Program, 2009).

A FOBT result will be considered positive if considerable levels of blood are present in the samples. On average about one in 14 people have a positive result. The presence of blood may be due to other conditions such as polyps, hemorrhoids, or inflammation of the bowel. If a positive result is obtained then diagnostic testing would be the next step. A colonoscopy is a procedure to examine the bowel (Australia National Bowel Cancer Screening Program, 2009).

Critically analyze the prevention and screening initiatives available including benefits and limitations, targeted groups, participation rates and funding.

The current phase of the National Bowel Cancer Screening Program in Australia began in July 2008 and offered testing to people turning 50 years of age between January 2008 and December 2010, and those turning 55 or 65 between July 2008 and December 2010. Those who are eligible to participate in the program got an invitation through the mail to complete a simple test called a Faecal Occult Blood Test (FOBT) in the confidentiality of their home. There is no cost to the patient involved in completing the FOBT process (Australia National Bowel Cancer Screening Program, 2009).

People who are in the eligible group included those Australians who were turning 50 between January 2008 and December 2010, and those turning 55 or 65 between July 2008 and December 2010, who have a Medicare card or DVA gold card. People who have temporary visas and are not permanent residents were not invited to participate in the program regardless of whether they are in the specified age range. Research has shown that the danger of developing bowel cancer goes up significantly after age 50. The National Health and Medical Research Council advice is that organized FOBT screening of average risk people should start at age 50. It is important that any screening program be implemented slowly in order to provide time to ensure that any health services that might be needed are able to meet any increased in demand (Australia National Bowel Cancer Screening Program, 2009).

Both men and women are in jeopardy of developing bowel cancer. In Australia, the lifetime possibility of developing bowel cancer before the age of 75 years is around 1 in 19 for men and 1 in 28 for women. This represents one of the highest rates of bowel cancer in the world. It is thought that the risk is greater for people who:

are aged 50 years and over have a considerable family history of bowel cancer or polyps have had Crohn's disease or ulcerative colitis (Australia National Bowel Cancer Screening Program, 2009).

A person is thought to have a considerable family history of bowel cancer if a close relative like a parent, brother, sister or child ever developed bowel cancer before the age of 55 or if more than one relative on the same side of your family has had bowel cancer. More than 75% of people who develop bowel cancer do not have a family history of bowel cancer (Australia National Bowel Cancer Screening Program, 2009).

The Bowel Cancer Screening Pilot Program was used to test the acceptability, feasibility, and cost effectiveness of bowel cancer screening in the Australia. It ran between November 2002 and June 2004 at three sites that included parts of Melbourne and Adelaide and in Mackay, Queensland. The Final Evaluation Report showed that a national bowel cancer screening program would be practical, suitable and cost effective. The Final Evaluation was supported by a number of studies that examined a range of different things. A total of 56,907 men and women were asked to participate in the pilot. The overall participation rate was 45.5%. This is comparable with participation rates in other, longer-established screening programs. Participation in the Pilot Program was higher among women (47.4%) than men (43.4%). The main reasons that were reported for participating in the program were precaution, prevention, early detection, health check important and peace of mind. "Of the 25,688 correctly completed FOBTs, 2,317 returned a positive result, giving an overall positivity rate for the Pilot of 9.0%, with a higher rate in men and amongst older participants" (Australia National Bowel Cancer Screening Program, 2009).

Critically examine the advice a Registered Nurse would give to a 38-year-old man with a family history of bowel cancer about bowel cancer prevention and screening options. Include the ethical, legal and professional implications of providing this advice.

Due to the fact that a person's risk for bowel cancer increases if they have a significant family history of bowel cancer or polyps it would very important that the nurse recommend that this patient undergo bowel cancer screening. A person is believed to have a significant…