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

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.

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.

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

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 ……..

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.

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

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.

Old age is not for the faint hearted

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

I read that – front page headline! It's a good example of why the Daily Mail can't be taken seriously. It's a political opinion piece, not journalism.

Who says £1M was blown? – the Daily Mail!

Who says the money was spent on 'Woke Groups'? – the Daily Mail.

Even if true, it's an odd choice of front page story for a national newspaper given what else was going on at the time. The Mail could have gone with the energy crisis, balance of trade, inflation, low economic growth, poor productivity, Northern Ireland border problems, Scottish Independence, enormous public sector borrowing, war in Ukraine, climate change, strikes, or what the Prime Ministerial candidates were saying. Instead of focusing on the NHS's staff shortage and huge post-COVID waiting list, and the fact the NHS costs £63billion a year to run and rising, instead the Daily Mail runs a story on Woke. Why?

As the NHS have about 110,000 vacancies, the alleged 'Woke Groups' are probably intended to avoid sacking foolish racists, sexists, bullies, and anyone else guilty of behaviours damaging in the workplace and to patients. Their skills are worth retaining provided they can be persuaded to keep inappropriate opinions to themselves at work.

Curious thing about anti-Woke is that people who like to call a spade a spade and think of themselves as robust are deeply offended by being asked to be polite, tactful and considerate of others!

I find it all very confusing because I'm against censorship.

Dave

Whilst bowl cancer is a concern may I remind members not to forget having their prostate tested !

H