Why Bother?

A senior consultant surgeon has spoken out against screening patients for bowel cancer in Scotland’s most deprived areas...because they are likely to suffer from other serious conditions which could kill them anyway.

Angus Macdonald, consultant colorectal surgeon at Monklands Hospital in Airdrie, said that in his experience in Lanarkshire, an area of high deprivation with one of the country’s lowest life expectancies, many patients with small tumours were more likely to die from other conditions before the cancer claims their life.

Health officials estimate that the NHS’s bowel cancer screening programme, for people between the ages of 50 and 74, could prevent 150 deaths annually. But Macdonald argues for some sections of the population it would not actually change the age at which a patient will die. “When you roll out a screening programme there is a very real possibility that you will identify cancers in the people who would normally have died from something else. We might operate on them and as a result we might actually shorten their lives.”

Research carried out by Macdonald, which is due to be published in the Journal of Colorectal Disease , adds weight to the principle of addressing the underlying determinants of ill-health such as socio-economic deprivation rather than of early detection and treatment of cancer as a principle health improvement strategy in such populations.

He said: “For the elderly time is precious. We’ll have some people coming up to their 50 years of marriage who have put together plans for over five or six years to save up for that once-in-a-lifetime holiday. When you tell them they have cancer they say they’ll cancel the cruise. I say, don’t. Go away and enjoy yourself if you can. It doesn’t matter if you have your operation just now or in two months, it is not going to make any difference at the end of the day.”