Residents are more likely to get, and die from, the disease than almost anywhere else in the world. Yet critical gaps in knowledge remain.
Middle-aged Tasmanians have one of the highest incidence and death rates from bowel cancer in the world, yet new research shows residents have a worrying lack of awareness of screening eligibility and risk factors.
“Public awareness of bowel cancer in Tasmania was found to be high overall, with an average awareness score of 68%, yet critical gaps were evident around a number of key risk factors, symptoms and screening,” said researchers, who surveyed 3700 residents of the Apple Isle.
One in three did not know that screening began at the age of 50, and half didn’t know that bowel cancer risk increases with age or were confident they would notice any symptoms.
Middle-aged Tasmanians have one of the highest incidence rates of bowel cancer, at 149 per 100,000, and death rates, at 32 per 100,000, in the world.
These findings were likely to be echoed around the country, lead author and rural health academic Simone Lee told The Medical Republic.
In fact, Tasmanian participation in the National Bowel Cancer Screening Program was, along with South Australia’s, the highest in the country at 49%, beating the national participation rate of 44%.
Ms Lee said that while these screening figures weren’t high enough, the higher rates found Tasmania could have been responsible for some of the higher incidence rates compared to other states.
Rural Tasmanians also reported long colonoscopy waiting lists, compounding the issue of delayed presentation. “A lot of people, including GPs, said they were waiting 12 months in the public system for a colonoscopy after getting a positive result. They should be seen optimally within 30 days. If you’ve got private cover, you can get in within two weeks,” said Ms Lee.
Survey respondents were least aware of risk factors such as low levels of physical activity (50% of respondents), alcohol consumption (42%) and diabetes (27%). They were most aware that having a close relative with bowel cancer, a low-fibre diet, and being overweight (all over 70%) were risk factors for the disease.
Yet alcohol played a “significant” role in bowel cancer development, with 9% of Australian cases attributable to alcohol consumption, the authors noted. Additionally, 6.5% of colon cancers could be attributed to insufficient physical activity levels in Australia, while type 2 diabetes increased the risk of colorectal cancer by up to 30%.
More than 85% of respondents knew that symptoms such as finding blood in their stools, bleeding and a change in bowel habits were a possible sign. Yet only 70% knew that the condition was linked to tiredness and anaemia, fewer than 60% about a lump in the abdomen and fewer than 55% about never feeling empty after a bowel movement.
The authors suggested that a social and mass media campaign to improve awareness of these symptoms and risk factors and the importance of screening patients with type 2 diabetes could contribute to a reduction in the rate of bowel cancer.
Ms Lee, who lectures at the Centre for Rural Health, first started looking at screening rates around five years ago, and she was surprised to find that particular areas of the state, like the Glamorgan Spring Bay LGA on the east coast, had some of the highest screening rates in the country.
“We were keen to know what was going on in those rural areas,” said Ms Lee. What we found was that strong community connections had an impact.
“You hear, ‘Well I screened because my neighbour had bowel cancer’. There’s a lot of word of mouth.”
International Journal of Environmental Research and Public Health 2022, online 28 January
