'Tis The Season To Talk About Poo
It’s a conversation that can save lives.
“Where’s my very anxious 36-year old patient?” asked the surgeon as she burst into the room, reading from the sheet of paper in her hands.
Her phrasing was familiar, the same words I had read on my referral, written by my GP.
I was about to have a colonoscopy to investigate the cause of symptoms that were consistent with bowel cancer -- “very anxious” was an understatement.
I had been waiting for this procedure for three months, the standard waiting period for an ‘urgent’ colonoscopy in the public system, I was shocked to discover.
It was a torturous wait. The prospect of a cancer diagnosis, however unlikely, consumed me -- I was terrified that my daughters, aged three and five, would grow up without a mother. The notion that I might miss out on knowing them as adults was indescribably distressing.
My husband, a pragmatic-minded health professional, assured me that the possibility that I had cancer was minimal -- I was low-risk. I recognised that he was right, but there was still the question of my symptoms, and in my panicked state I couldn’t be reassured. The colonoscopy would give me the definitive answer I needed.
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I was lucky (in a way) -- it turned out I had ulcerative colitis, which I keep in check with medication. But I had good reason to fear bowel cancer, the second most common cancer for men and women in Australia. A few weeks ago, it claimed the life of Rani Middleton, a 34-year-old teacher from Broome who recorded her journey in a widely-shared and beautifully written blog. Rani, the mother of a three-year-old son, was diagnosed with bowel cancer just 12 months ago.
Awareness is critical in the fight to reduce bowel cancer deaths, but, as Rani writes in her blog, it’s a topic that many people avoid -- who likes talking about poo? She reports an exchange with a friend, a PE teacher who wants to focus on bowel cancer awareness for a class project.
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“There’s still a stigma about talking about our digestive system -- which I think is a real barrier to raising awareness about how to detect bowel problems,” she tells him. “Knowledge is power.”
One way to overcome this stigma is with humour. A TV ad for bowel cancer screening commissioned by the NSW government used this approach. It shows a group of friends, some sipping wine, sitting around a table. “Tomorrow I want to do a poo, and then poke it with a little stick,” announces one woman nonchalantly.
To raise awareness about bowel cancer, Rani’s friend’s students ran a basketball tournament called Hoops for Poops, a bake sale, a sausage sizzle and some suitably off-colour games like a competition to see who could lick Nutella off a plate the fastest. In a letter to the class, Rani writes: “Humour is a great tool to raise awareness about things we’d rather not think about: like cancer in your poo-tube. Even though I have a family history of bowel cancer, it wasn’t really on my radar.”
Rani’s grandmother died from bowel cancer, and her father encouraged her to get a colonoscopy when she turned 30, but she was pregnant and didn’t get around to it.
“Imagine if I’d had the awareness to get a colonoscopy earlier. I wouldn’t have to go through chemo. I’d still have all of my large intestine. I wouldn’t have had to tell my parents, my brother and sister, and my two-year-old son that I have cancer.”
The Australian Government runs the National Bowel Cancer Screening Program, which sends out kits containing an immunochemical faecal occult blood test (iFOBT) to eligible people aged between 50 and 74. The test is free and picks up 12,000 suspected or detected cancers each year. This type of regular screening can reduce deaths from bowel cancer by 15 to 25 percent.
But not enough people complete the test. In 2015-16, just 40 percent of people who received bowel cancer screening kits in the mail returned the test. This is crazy -- if detected early, 90 percent of bowel cancer cases are cured.
Christmas, just a few weeks away, is the perfect opportunity to talk about our families’ medical history – including bowel cancer. As you swallow your last mouthful of Christmas dinner, take a breath and ask your parents, grandparents, aunts and uncles aged 50 and over if they’ve poked their poo with a stick recently and returned their FOBT test.
As Rani writes in her letter to the PE class, “You have the chance to take control of your health. You have the chance to get to know your genes, your family history-- have any of your relatives had cancer? If so, what type? Ask your family and doctor about it. Google it. Equip yourself with knowledge.”
I’m not off the hook -- ulcerative colitis increases my risk of bowel cancer and once I’m in my 40s, I’ll have regular colonoscopies. But, ironically, it’s probably improved my overall health -- I’m very conscious about triggers like stress and diet.
And my brush with bowel cancer has had another effect: these days, I have zero qualms about talking about bowel health, even if it means talking about poo.