Health & Lifestyle

Lung, Bowel Cancers more Likely to be Diagnosed in Later Stages

Marilyn Nelson before a hospital CT scanFor many people the shock of a cancer diagnosis can only be tempered by the phrase: “at least we caught it early”.

But new data shows this can’t be said for many patients diagnosed with two of Australia’s most common cancers.

For the first time Cancer Australia has produced figures showing which cancers are identified early and which are spotted in later stages.

It reveals lung cancer and bowel cancer are the most advanced when patients are diagnosed.

Just 18 per cent of lung cancer patients are diagnosed at an early stage and 46 per cent of bowel cancers patients.

By contrast 92 per cent of melanomas are diagnosed early, as well as 82 per cent of prostate cancers, and 77 per cent of female breast cancers.

But the data also showed bowel cancer was being detected early among people aged over 50 — suggesting the national bowel screening program had been effective.

“Participants in the bowel cancer screening program tended to have less advanced cancers,” said Cancer Australia chief executive Dr Helen Zorbas.

“I think there’s strong data that indicates the benefit of screening.”

‘I don’t want to talk about poo … get over that’

Stephanie Bansemer-Brown said she believed much of the delay in diagnosis of bowel cancer related to stigma.

“People say, ‘I don’t want to talk about poo, I don’t want to do a test on poo’ — get over that,” she said.

She was just 41 when she was diagnosed with stage 3 bowel cancer.

Stephanie Bansemer-Brown in hospital

“I was a new mum with a two-and-a-half year old,” she said.

“I was working for a TV station at the time, head of marketing, so a fairly high-pressured environment.”

She’d been to her GP with blood in her stool 18 months earlier but was dismissed as having pregnancy-related haemorrhoids.

It was a discussion with her sister that eventually prompted her to insist on a colonoscopy.

It revealed she had bowel cancer and that it had spread to some of her lymph nodes.

“My initial reaction was ‘this can’t be happening, how can I have a bowel cancer? I’m too young’.

“I wasn’t sure whether I was going to come out the other side to be honest.”

What followed was surgery, a temporary ileostomy (stoma) bag and six months of chemotherapy.

Stephanie Bansemer-Brown with her young son in 2012“I had a really little boy who didn’t really know what was going on. For me it was, let’s just tackle this head on and that’s what I did.”

Ms Bansemer-Brown is six years cancer free and said she’d like to see more frank discussions about bowel habits among the public and GPs.

“I think people think that it’s an old person’s disease,” she said. “It’s not about age.

“If you’re presenting with symptoms or a family history, then you need to have a check. I know if I left it any longer I wouldn’t be sitting here today.”

Anybody can get lung cancer — not just smokers

The data also showed the majority of lung cancers, 42 per cent, were spotted at stage 4 and had spread in the body.

Patient Marilyn Nelson also believed stigma was an issue with detecting lung cancer. She said since she’d been diagnosed, people often mistakenly believed she’d been a smoker and were unsympathetic.

“For someone who’s got this awful disease it’s like a whack in the face. It’s awful,” she said.

“There’s a large swag of us who never even touched a cigarette. Anybody can get lung cancer.”

Her cancer was only detected by pure luck at stage 2 when she was having a scan for an unrelated issue.

“I had no symptoms, I had no risk factors and so it was just complete bolt out of the blue,” she said.

“I didn’t even have a cough — nothing.”

The scan showed a mass in the top of her right lung and it had spread to the lining of her lung.

“It was a shock. I was 61 and I was still working full time,” she said.

Ms Nelson has been living with cancer for the past five years, undergoing surgeries, chemotherapy, radiation, and now targeted genetic therapies in a clinical trial.

She said during her treatment she’d only met a few people who were detected early.

Brisbane retiree Marilyn Nelson, who has advanced lung cancer, says she has never smoked in her life

“Almost all of them are picked up by chance when they have some sort of an X-ray or CT scan or something else.”

For Ms Nelson, it makes sense to have a national screening program for lung cancer.

Her experience, she said, showed Australia needed to start population-based screening using low dose CT scans, similar to the United States.

“What’s happening over there is they’re picking up lots more people at early stages and that means it’s at a time when they may be able to cure them,” she said. “It just has to be done. It’s going to save so many lives.”

‘Stage of diagnosis’ data closes the loop

Cancer Australia has collected the “stage at diagnosis” data as part of a larger project to map early detection and outcomes in Australia.

The 2011 data will be married with survival rates from 2016, to paint a detailed picture of cancer in Australia.

Dr Zorbas said the new data was the “missing link” for researchers between cancer prevalence rates and death rates.

“Our ability to then look at that picture of exploring the relationships between stage at diagnosis, the treatments that were received and then looking at outcomes is really going to be the nirvana in helping us understand differences in survival among different demographic groups,” she said.

“Ultimately that will inform both research efforts but also policy and practice in at a population level.”

Dr Zorbas said there was some good news in the statistics. It showed Australia was doing well in early stage diagnosis compared to the UK and Canada.

The data was also broken down by population groups, with Aboriginal and Torres Strait Islander people tending to have lower proportion of stage-one cancer for female breast, bowel and prostate cancers, as well as higher proportions of advanced cancers.

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