Vita brevis

I recently did a Bowel Cancer screening test

[ the process for which is now much tidier than it was ]

When the good news came, I was surprised to read this in the letter:

[…] You will be sent another test kit in two years

if you remain in the eligible age-range of 58-74.

Obvious conclusion being that it’s not worth testing people over 74

MichaelG.

Posted by Michael Gilligan on 15/09/2022 00:18:37:

I recently did a Bowel Cancer screening test ... Obvious conclusion being that it’s not worth testing people over 74

MichaelG.

Well, you've certainly opened a can of worms. The obvious response is, "Not worth it to whom by testing people over 74?" Clearly, the individual may think it's worth a lot, but the funding organisation may consider that, for each life saved, the cost per added year of life, plus the treatment cost, plus the added pension payouts, etc. isn't good financial value. The purely medical aguments around screening programmes are complex enough, without considering finance and politics.

To illustrate some of the problems around screening, a screening programme is only appropriate if it causes an acceptably small amount of harm, AND if the disease's natural history is known, so that it has been established that early diagnosis increases survival significantly, AND if there is effective treatment, AND if the disease is 'sufficiently' prevalent in the screened population, AND if the performance of the screening test(s) is (are) good enough. (Capitalised AND to indicate logical AND). This onerous requirement makes prostate screening rather dubiously beneficial to the population, mainly because treatment often causes significant disruption to a symptomless individual, and lots of old men die with cancer cells in their prostate, but not from the disease.

Another problem is that, if the prevalence of a screened-for disease is low (most are), and the screening test is not very, very nearly perfect (none are), the maths generally results in the number of false positives and/or false negatives significantly exceeding the number of true positive diagnoses. This isn't because of medical failings, it's just maths.

If you are found to have a condition predisposing to colonic malignancy (some inflammatory bowel diseases, polyposis coli, etc.), one would hope that you would be offered life-time screening, even by the creaking NHS. And, if you were not, paying for it might be medically wise, but financially a difficult decision.

We were told that if you were clear at 74, the likely hood of developing after 74 was greatly reduced (statistically).

Bob

Keep the thoughts coming … this could get fascinating

I might add that [being already 73] … BER was the term that sprang to mind.

MichaelG.

.

Ref. __ https://skymartsales.com/glossary/ber.php

Edited By Michael Gilligan on 15/09/2022 07:39:20

I don't think that's correct. The probability of developing (most types of) cancer increases with age. However, the risk of dying from the cancer may decrease, because you'll perhaps die from any of the other causes of death, which are waiting to get you. It is true that some cancers (in some people) are less aggressive with age. It's complicated. And, as you get older, you're more likely to suffer complications from treatment, because you'll be generally less robust than you were. Isn't getting old fun?

I have now done two after 74 we just have to phone and request a test.

I wonder if part of the 74 thing is to do with people getting upset over their dead relatives getting reminder letters for such stuff.

There seems to be unlimited NHS resources for sticking things into our nether regions

I had to tell the hospital that I was away on a 2 year sabbatical to Peru to stop them bugging me

Phone calls, letters, even at 8am one saturday morning "where are you?"

I would like to see those resources diverted to dental surgeries who seem to be impossible to get a hold of even when we're desperate

Last week my dental appointment which was made only 5 days previously for 3 months hence got cancelled, so it basically dropped straight out of the computer after the phone was hung up

edit: maybe it's those aliens and their obsession with probes

Edited By Ady1 on 15/09/2022 09:07:36

Yes, I would agree with that., which is a good reason for not screening over 74. Effectively by screening up to that age you have covered all those who are prone to bowel cancers at an earlier age either because of their genetics or thier lifestyle. It also free's up a certain amount of cash that can then be used for stuff like hip replacements and cateracts which dispropotional benifit the elderly. Just assuming that the state doesn't care for the over 74's is careless bias.

regards Martin

Deleted by V8

Edited By V8Eng on 15/09/2022 09:05:22

Agree - it does help free up vitally needed cash for patient care -

Article: NHS blows £1Million pounds on 'woke groups' for staff - Daily Mail 19 Aug 2022

same old, same old ........

I got a good clean out at 55, campylobacter, probably from eating reheated chicken

3 weeks and 2 stones later I felt like a new man, 50 years of accumulated junk had been completely removed from my innards

With hindsight I would recommend it, but it's not a lot of fun

The age range covered by the tests is because statistically, that is the age range where most bowel cancers are likely to occure. After 74 statistically, if you have not developed symptoms then you are 'unlikely' to.IF simptoms did develop, then your local GP would be able to refer for subsequent investigation and in most cases would be treatable.

For those who are over 74, you can request to continue receiving test kits.

As one who has had bowel cancer and been through more operations and procedures than you could shake a stick at, the continuation of testing could be a life saver.

Apt choice of words

It's not everyday you get to see your own insides on a screen in real time.

Rob

Edited By Grindstone Cowboy on 15/09/2022 09:59:30

Just received my third notification, I ignored the first two but doc says an early catch is very treatable so going to go for it. Hope it’s clear as having a camera boldly going where no man has gone before is not on my bucket list. A friend used to have us in stitches with his experiences of cameras investigating all his male orifices, although he was hilariously funny it didn’t make me feel I was missing out.

Mike

Ah, yes, campylobacter. The digestive system Dyno-rod!

It is not true that the likelihood of developing colon cancer decreases after 74. Please substantiate any claim to the contrary.

Whether or not it may be true that the majority of colon cancers in people with a genetic predisposition or a predisposing co-morbidity have manifested themselves before 74 isn't very relevant, because these represent only a small minority of colon cancers. However, the risk of developing colon cancer if you have ulcerative colitis or Crohn's disease increases steadily with the time you've had the disease - and therefore age. So, the idea that it becomes a lower probability with age in these circumstances is a myth. The reason for the upper age limit is for the reasons I have previously alluded to.

It's probably true that most colon cancers occur in the 58-74 age range, but that's not a probability statement. It's the number of cancers in the population. People, and thus their cancers, get fewer with age, so it's entirely what you should expect. Think how small the absolute number - not the proportion - of cancers is in the 100-year-plus population. Very few, because the population is so small (even if they were found all to have cancer). So, yes, in the population, the number of colon cancers will reduce with age. That tells you nothing about the probability of being afflicted, however.

As for a statutory BER age cut-off, thank goodness it would be political suicide to go public with one. However, like all public policy (real or fantasy), it's complicated...

My friends and I watched one of 'our crowd' slowly getting feebler. A stoic, we didn't know he was getting increasing angina. Eventually, he went to his GP about something else, but mentioned his chest discomfort was now more-or-less continuous. Ambulance from surgery to hospital and multiple coronary artery bypass grafts the next day. He was 81. He's now about four years older and transformed. The problem is that he never expected to live for so long, and is complaining that he's rapidly running out of money. He's not happy about it. He claims he would have been happy to have slipped away four years ago.

Moral: you've got to go sometime; interference sometimes misfires.

Old age is not for the faint hearted

I will turn 76 this month, where has all the time gone, and have just had my fifth colonoscopy where more polyps were removed. I was informed that because they have found polyps on previous procedures then I am now to receive a colonoscopy every two years, I am glad that at the age I am then the NHS is concerned enough about my fate to continue providing the procedures for removing any subsequent polyps that manifest themselves in my bowel. Although sedated during the procedure I find it fascinating watching the travel of the scope through my nether regions and even more intriguing when polyps are captured and removed. Although the preparation for the colonoscopy is not very pleasant, that is emptying the bowel with vile preparations, the procedure itself is not painful and the staff in the theatre endeavour to not humiliate the patients. My two penny worth is if offered the test either screening or internal examination then have it, we are lucky to live in a society that provides free health care, there are many countries in the world where this is not so. Dave W

Am afraid that my perception is that once you get over 70 the NHS attitude tends to be "Well, they haven't got long to go, anyway so not worth spending too much time or money on them"

The gretaest contact with my Gp in the last 6 years or so iwas to be see nurse for blood tests, a year or more ago.

(After I'd convinced the surgery that, by means of a one week diary, that I did not have high blood pressure and had not had a stroke! )

My wife, who has other health problems, was taken aback to be asked "And how is your diabetes"?

Nothing like keeping accurate records!

My only contact with NHS, Thank Goodness, is only for Flu or Covid jabs. And hope to keep it that way!

Cynical? DEFINITELY

Howard