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Dear Sir,It is now over five years since I wrote to you stating that, The only pilot we need is someone with the courage and funding to roll out a national \u2026 programme to save over 500 Kiwi lives each year! 1 The then quoted Level 1A prospective randomised evidence confirming a 50% reduction in left-sided bowel cancer deaths from flexible sigmoidoscopy screening2 has been ignored by most in New Zealand, even though similar results have now come out of Norway.3I have just completed a short contract for two DHBs to help take 200 people off their colonoscopy waiting list, and I write with concern, noting that only one of these people had decided to purchase a Faecal Occult Blood Test (FOBT) kit from a pharmacy. She returned a positive test and we subsequently removed a large premalignant polyp, thus probably preventing her succumbing prematurely to bowel cancer. Is it acceptable that the Ministry of Health actively excludes the use of FOBT around New Zealand as a referral reason for colonoscopy?4 Is it ethical that they knowingly allow the premature death of hundreds of New Zealanders each year to bowel cancer? What would happen if every family who lost a loved one to bowel cancer challenged the Ministry of Health for not acting to detect early bowel cancer?Bowel cancer screening has been proven since it was first published 22 years ago,5,6 so do we really need to reinvent the wheel here? And why are we debating the cost of expensive pharmaceuticals for metastatic bowel cancer? Weve known for five years2 that we can halve the number of left-sided metastatic bowel cancer deaths by flexible sigmoidoscopic screening, which in turn would halve the pharmaceutical bills!Its a sad fact that New Zealand has the worst bowel cancer statistics of any developed country, and its obviously because we havent developed a bowel cancer screening program. We need to end this discrimination by region. Should all New Zealanders between the age of 50-75 now shift to live in the Waitemata area, so they are not further discriminated against by where they live? And why is a positive FOBT the most common reason for a colonoscopy in Australia, and the least common reason in New Zealand?I am hoping to turn 50 next year, and am feeling guilty about planning to have my first screening colonoscopy, noting that many of my colleagues have also had a screening procedure at this age. I would suggest that as a profession, it is not appropriate for us to screen ourselves for this disease, and not try and help establish a national screening programme similar to our own personal practice. With sadness, I accept that we live in a society where The rich stay healthy. The sick stay poor .7If we, as a nation, viewed over 500 unnecessary premature annual deaths as a war, then history would demonstrate that New Zealand would send our most talented youths into battle to fight this on our behalf. I suggest that we now view our fight against this occult disease as a battle, and train appropriate warriors to fight on our nations behalf. Instead of posing with All Blacks in their dressing room, I suggest that our Prime Minister should try and recruit retiring professional rugby players (with a courageous heart, proven trainability and world beating hand-eye coordination skills) and get them into the screening flexible sigmoidoscopy work force. If Richie McCaw can take one year to learn to fly a helicopter, then how long would it take him to learn the art of screening flexible sigmoidoscopy? We should invite him and his sporting colleagues, both men and women, to join us at the coalface to prevent the unnecessary premature death of too many in our national clan.Top sports coaches and team members depart when their national team cannot deliver winning results. Therefore, is it time for those who partook in the 1998 Working Party on Population Screening for Colorectal Cancer,8 and subsequent review,9 who still work with the Ministry of Health to now hand on the baton? We can only see further because we stand on the shoulders of giants, but I do not accept that colonoscopy resources are our limiting factor the real limiting factor is the lack of leadership to promote and fund bowel cancer screening.Sir, could you please convey to Prime Minister John Key that we are many years overdue for a new innovative bowel cancer screening strategy. He needs to take his head out of the sand and act responsibly now to prevent the continuing unnecessary premature demise of over 500 New Zealanders each year.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington -

Acknowledgements

Correspondence

Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington

Correspondence Email

guy@gold-book.net

Competing Interests

Mr Hingston is an experienced colonoscopist who derives income from performing colonoscopy.

'- - Guy Hingston. We dont need a pilot bowel cancer screening programme: Please just get on with it! NZMJ 25 June 2010, Vol 123 No 1317; ISSN 1175 8716 URL: http://www.nzma.org.nz/journal/123-1317/4200/ Wendy S Atkin, Rob Edwards, Ines Kralj-Hans, Kate Wooldrage, Andrew R Hart, John M A Northover, D Max Parkin, Jane Wardle, Stephen W Duffy, Jack Cuzick. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-33. Published Online April 28, 2010 DOI:10.1016/S0140-6736(10)60551-X \u00d8yvind Holme, Magnus L\u00f8berg, Mette Kalager, Michael Bretthauer, Miguel A. Hern\u00e1n, Eline Aas, Tor J. Eide, Eva Skovlund, J\u00f8rn Schneede, Kjell Magne Tveit, Geir Hoff. Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: A Randomized Clinical Trial. JAMA. 2014;312(6):606-615. doi.10.1001/jama.2014.8266 https://www.health.govt.nz/system/files/documents/pages/referral_criteria_for_direct_acc ess_outpatient_colonoscopy.pdf Mandel, J.S, Bond, J.H, Church, T.R, Snover, D.C, Bradley, G.M, Schuman, L.M, Ederer, F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N.Engl.J.Med 1993;328(19):1365-1371 Hewitson P, Glasziou PP, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test. Hemoccult. Cochrane Database of Systematic Reviews 2007, Issue 1.Art. No.: CD001216. DOI:10.1002/14651858.CD001216.pub2./14651858.CD001216.pub2. http://www.u2.com/lyrics/51 https://nhc.health.govt.nz/system/files/documents/publications/colorectalcancer.pdf https://www.nsu.govt.nz/system/files/page/colorectal-cancer-screening-advice.pdf- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Dear Sir,It is now over five years since I wrote to you stating that, The only pilot we need is someone with the courage and funding to roll out a national \u2026 programme to save over 500 Kiwi lives each year! 1 The then quoted Level 1A prospective randomised evidence confirming a 50% reduction in left-sided bowel cancer deaths from flexible sigmoidoscopy screening2 has been ignored by most in New Zealand, even though similar results have now come out of Norway.3I have just completed a short contract for two DHBs to help take 200 people off their colonoscopy waiting list, and I write with concern, noting that only one of these people had decided to purchase a Faecal Occult Blood Test (FOBT) kit from a pharmacy. She returned a positive test and we subsequently removed a large premalignant polyp, thus probably preventing her succumbing prematurely to bowel cancer. Is it acceptable that the Ministry of Health actively excludes the use of FOBT around New Zealand as a referral reason for colonoscopy?4 Is it ethical that they knowingly allow the premature death of hundreds of New Zealanders each year to bowel cancer? What would happen if every family who lost a loved one to bowel cancer challenged the Ministry of Health for not acting to detect early bowel cancer?Bowel cancer screening has been proven since it was first published 22 years ago,5,6 so do we really need to reinvent the wheel here? And why are we debating the cost of expensive pharmaceuticals for metastatic bowel cancer? Weve known for five years2 that we can halve the number of left-sided metastatic bowel cancer deaths by flexible sigmoidoscopic screening, which in turn would halve the pharmaceutical bills!Its a sad fact that New Zealand has the worst bowel cancer statistics of any developed country, and its obviously because we havent developed a bowel cancer screening program. We need to end this discrimination by region. Should all New Zealanders between the age of 50-75 now shift to live in the Waitemata area, so they are not further discriminated against by where they live? And why is a positive FOBT the most common reason for a colonoscopy in Australia, and the least common reason in New Zealand?I am hoping to turn 50 next year, and am feeling guilty about planning to have my first screening colonoscopy, noting that many of my colleagues have also had a screening procedure at this age. I would suggest that as a profession, it is not appropriate for us to screen ourselves for this disease, and not try and help establish a national screening programme similar to our own personal practice. With sadness, I accept that we live in a society where The rich stay healthy. The sick stay poor .7If we, as a nation, viewed over 500 unnecessary premature annual deaths as a war, then history would demonstrate that New Zealand would send our most talented youths into battle to fight this on our behalf. I suggest that we now view our fight against this occult disease as a battle, and train appropriate warriors to fight on our nations behalf. Instead of posing with All Blacks in their dressing room, I suggest that our Prime Minister should try and recruit retiring professional rugby players (with a courageous heart, proven trainability and world beating hand-eye coordination skills) and get them into the screening flexible sigmoidoscopy work force. If Richie McCaw can take one year to learn to fly a helicopter, then how long would it take him to learn the art of screening flexible sigmoidoscopy? We should invite him and his sporting colleagues, both men and women, to join us at the coalface to prevent the unnecessary premature death of too many in our national clan.Top sports coaches and team members depart when their national team cannot deliver winning results. Therefore, is it time for those who partook in the 1998 Working Party on Population Screening for Colorectal Cancer,8 and subsequent review,9 who still work with the Ministry of Health to now hand on the baton? We can only see further because we stand on the shoulders of giants, but I do not accept that colonoscopy resources are our limiting factor the real limiting factor is the lack of leadership to promote and fund bowel cancer screening.Sir, could you please convey to Prime Minister John Key that we are many years overdue for a new innovative bowel cancer screening strategy. He needs to take his head out of the sand and act responsibly now to prevent the continuing unnecessary premature demise of over 500 New Zealanders each year.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington -

Acknowledgements

Correspondence

Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington

Correspondence Email

guy@gold-book.net

Competing Interests

Mr Hingston is an experienced colonoscopist who derives income from performing colonoscopy.

'- - Guy Hingston. We dont need a pilot bowel cancer screening programme: Please just get on with it! NZMJ 25 June 2010, Vol 123 No 1317; ISSN 1175 8716 URL: http://www.nzma.org.nz/journal/123-1317/4200/ Wendy S Atkin, Rob Edwards, Ines Kralj-Hans, Kate Wooldrage, Andrew R Hart, John M A Northover, D Max Parkin, Jane Wardle, Stephen W Duffy, Jack Cuzick. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-33. Published Online April 28, 2010 DOI:10.1016/S0140-6736(10)60551-X \u00d8yvind Holme, Magnus L\u00f8berg, Mette Kalager, Michael Bretthauer, Miguel A. Hern\u00e1n, Eline Aas, Tor J. Eide, Eva Skovlund, J\u00f8rn Schneede, Kjell Magne Tveit, Geir Hoff. Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: A Randomized Clinical Trial. JAMA. 2014;312(6):606-615. doi.10.1001/jama.2014.8266 https://www.health.govt.nz/system/files/documents/pages/referral_criteria_for_direct_acc ess_outpatient_colonoscopy.pdf Mandel, J.S, Bond, J.H, Church, T.R, Snover, D.C, Bradley, G.M, Schuman, L.M, Ederer, F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N.Engl.J.Med 1993;328(19):1365-1371 Hewitson P, Glasziou PP, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test. Hemoccult. Cochrane Database of Systematic Reviews 2007, Issue 1.Art. No.: CD001216. DOI:10.1002/14651858.CD001216.pub2./14651858.CD001216.pub2. http://www.u2.com/lyrics/51 https://nhc.health.govt.nz/system/files/documents/publications/colorectalcancer.pdf https://www.nsu.govt.nz/system/files/page/colorectal-cancer-screening-advice.pdf- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Dear Sir,It is now over five years since I wrote to you stating that, The only pilot we need is someone with the courage and funding to roll out a national \u2026 programme to save over 500 Kiwi lives each year! 1 The then quoted Level 1A prospective randomised evidence confirming a 50% reduction in left-sided bowel cancer deaths from flexible sigmoidoscopy screening2 has been ignored by most in New Zealand, even though similar results have now come out of Norway.3I have just completed a short contract for two DHBs to help take 200 people off their colonoscopy waiting list, and I write with concern, noting that only one of these people had decided to purchase a Faecal Occult Blood Test (FOBT) kit from a pharmacy. She returned a positive test and we subsequently removed a large premalignant polyp, thus probably preventing her succumbing prematurely to bowel cancer. Is it acceptable that the Ministry of Health actively excludes the use of FOBT around New Zealand as a referral reason for colonoscopy?4 Is it ethical that they knowingly allow the premature death of hundreds of New Zealanders each year to bowel cancer? What would happen if every family who lost a loved one to bowel cancer challenged the Ministry of Health for not acting to detect early bowel cancer?Bowel cancer screening has been proven since it was first published 22 years ago,5,6 so do we really need to reinvent the wheel here? And why are we debating the cost of expensive pharmaceuticals for metastatic bowel cancer? Weve known for five years2 that we can halve the number of left-sided metastatic bowel cancer deaths by flexible sigmoidoscopic screening, which in turn would halve the pharmaceutical bills!Its a sad fact that New Zealand has the worst bowel cancer statistics of any developed country, and its obviously because we havent developed a bowel cancer screening program. We need to end this discrimination by region. Should all New Zealanders between the age of 50-75 now shift to live in the Waitemata area, so they are not further discriminated against by where they live? And why is a positive FOBT the most common reason for a colonoscopy in Australia, and the least common reason in New Zealand?I am hoping to turn 50 next year, and am feeling guilty about planning to have my first screening colonoscopy, noting that many of my colleagues have also had a screening procedure at this age. I would suggest that as a profession, it is not appropriate for us to screen ourselves for this disease, and not try and help establish a national screening programme similar to our own personal practice. With sadness, I accept that we live in a society where The rich stay healthy. The sick stay poor .7If we, as a nation, viewed over 500 unnecessary premature annual deaths as a war, then history would demonstrate that New Zealand would send our most talented youths into battle to fight this on our behalf. I suggest that we now view our fight against this occult disease as a battle, and train appropriate warriors to fight on our nations behalf. Instead of posing with All Blacks in their dressing room, I suggest that our Prime Minister should try and recruit retiring professional rugby players (with a courageous heart, proven trainability and world beating hand-eye coordination skills) and get them into the screening flexible sigmoidoscopy work force. If Richie McCaw can take one year to learn to fly a helicopter, then how long would it take him to learn the art of screening flexible sigmoidoscopy? We should invite him and his sporting colleagues, both men and women, to join us at the coalface to prevent the unnecessary premature death of too many in our national clan.Top sports coaches and team members depart when their national team cannot deliver winning results. Therefore, is it time for those who partook in the 1998 Working Party on Population Screening for Colorectal Cancer,8 and subsequent review,9 who still work with the Ministry of Health to now hand on the baton? We can only see further because we stand on the shoulders of giants, but I do not accept that colonoscopy resources are our limiting factor the real limiting factor is the lack of leadership to promote and fund bowel cancer screening.Sir, could you please convey to Prime Minister John Key that we are many years overdue for a new innovative bowel cancer screening strategy. He needs to take his head out of the sand and act responsibly now to prevent the continuing unnecessary premature demise of over 500 New Zealanders each year.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington -

Acknowledgements

Correspondence

Guy Hingston, Department of Surgery and Anaesthesia, University of Otago, Wellington

Correspondence Email

guy@gold-book.net

Competing Interests

Mr Hingston is an experienced colonoscopist who derives income from performing colonoscopy.

'- - Guy Hingston. We dont need a pilot bowel cancer screening programme: Please just get on with it! NZMJ 25 June 2010, Vol 123 No 1317; ISSN 1175 8716 URL: http://www.nzma.org.nz/journal/123-1317/4200/ Wendy S Atkin, Rob Edwards, Ines Kralj-Hans, Kate Wooldrage, Andrew R Hart, John M A Northover, D Max Parkin, Jane Wardle, Stephen W Duffy, Jack Cuzick. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-33. Published Online April 28, 2010 DOI:10.1016/S0140-6736(10)60551-X \u00d8yvind Holme, Magnus L\u00f8berg, Mette Kalager, Michael Bretthauer, Miguel A. Hern\u00e1n, Eline Aas, Tor J. Eide, Eva Skovlund, J\u00f8rn Schneede, Kjell Magne Tveit, Geir Hoff. Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: A Randomized Clinical Trial. JAMA. 2014;312(6):606-615. doi.10.1001/jama.2014.8266 https://www.health.govt.nz/system/files/documents/pages/referral_criteria_for_direct_acc ess_outpatient_colonoscopy.pdf Mandel, J.S, Bond, J.H, Church, T.R, Snover, D.C, Bradley, G.M, Schuman, L.M, Ederer, F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N.Engl.J.Med 1993;328(19):1365-1371 Hewitson P, Glasziou PP, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test. Hemoccult. Cochrane Database of Systematic Reviews 2007, Issue 1.Art. No.: CD001216. DOI:10.1002/14651858.CD001216.pub2./14651858.CD001216.pub2. http://www.u2.com/lyrics/51 https://nhc.health.govt.nz/system/files/documents/publications/colorectalcancer.pdf https://www.nsu.govt.nz/system/files/page/colorectal-cancer-screening-advice.pdf- -

Contact diana@nzma.org.nz
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