Kiaoda.

Kiaoda.

I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. Bowel cancer is the second highest cause of cancer death in New Zealand. One in ten Kiwis diagnosed are under fifty, and every day around three New Zealanders die from bow cancer. Now keep those figures in mind when I tell you that Health Minister Simeon Brown has announced the government is lowering the screening from sixty to fifty eight for all Kiwis and canned plans to lower the age for Maldi and Pacific men to fifty. That might be a good fit for the Pakiha majority, but less so for Maldi and Pacific, given more of those groups developed cancer earlier. For example, about twenty six percent of bowel cancers and Pacific peoples occur between fifty and fifty nine years old, compared to about eleven percent for non multi or Pacific populations. Today on the front page, University of the Targo professor of colorectal surgery, Frank Brazell joins us to discuss what needs to be done to prevent this disease. Frank, you wrote a pretty scathing editorial in the latest issue of the New Zealand Medical Journal, tell me about it.

I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. Bowel cancer is the second highest cause of cancer death in New Zealand. One in ten Kiwis diagnosed are under fifty, and every day around three New Zealanders die from bow cancer. Now keep those figures in mind when I tell you that Health Minister Simeon Brown has announced the government is lowering the screening from sixty to fifty eight for all Kiwis and canned plans to lower the age for Maldi and Pacific men to fifty. That might be a good fit for the Pakiha majority, but less so for Maldi and Pacific, given more of those groups developed cancer earlier. For example, about twenty six percent of bowel cancers and Pacific peoples occur between fifty and fifty nine years old, compared to about eleven percent for non multi or Pacific populations. Today on the front page, University of the Targo professor of colorectal surgery, Frank Brazell joins us to discuss what needs to be done to prevent this disease. Frank, you wrote a pretty scathing editorial in the latest issue of the New Zealand Medical Journal, tell me about it.

The Ministry Health on the sixth to March announced the changes to the bow screening and has reduced it from sixty to fifty eight. This seems to be the least possible that he can do. When the Prime Minister in the pre election TV interviews, when they have those leader's debates, it's said they were reduced to the same as Australia.

The Ministry Health on the sixth to March announced the changes to the bow screening and has reduced it from sixty to fifty eight. This seems to be the least possible that he can do. When the Prime Minister in the pre election TV interviews, when they have those leader's debates, it's said they were reduced to the same as Australia.

Sitting our audience right up there is Amy Rose Yates. She's got stage four terminal bowl cancer and she's in her early thirties. The national age for screening in this country is sixty. Her question is will either of you lower the age of screening and save the lives of Kiwis?

Sitting our audience right up there is Amy Rose Yates. She's got stage four terminal bowl cancer and she's in her early thirties. The national age for screening in this country is sixty. Her question is will either of you lower the age of screening and save the lives of Kiwis?

Yeah, I'd like to do that, and we've also said we'd like to do it. On breast cancer screening, we're extending it from sixty nine to seventy four. Saving sixty five lives makes sense that we should do the same on bell cancer.

Yeah, I'd like to do that, and we've also said we'd like to do it. On breast cancer screening, we're extending it from sixty nine to seventy four. Saving sixty five lives makes sense that we should do the same on bell cancer.

So what will you bring it?

So what will you bring it?

Because lady, here's the problem, right, we have a fifteen percent higher mortality rate on cancer than the equivalents in Australia. Do, and so we actually have to close that cancer gap big time.

Because lady, here's the problem, right, we have a fifteen percent higher mortality rate on cancer than the equivalents in Australia. Do, and so we actually have to close that cancer gap big time.

Okay, so the bowel cancer screen do you want to bring it down as well? Chris sippins, Well, yes, absolutely I do, so you'll make that commitment to bring it down absolutely now.

Okay, so the bowel cancer screen do you want to bring it down as well? Chris sippins, Well, yes, absolutely I do, so you'll make that commitment to bring it down absolutely now.

Australia at that time head it down to fifty and also was possible to get it from forty five by having a discussion with your GP about the pros and cons screening and then the GP will send your name through for you to be screened if it was appropriate. Australia has subsequently moved to forty five for everyone and you can actually get it done four by having that same discussion that previously you had to have. From forty five. Australia has moved a lot. You's moved a little. Now. This is on a background to spending twenty four years introducing screening from the moment, it was from the first report saying that there would be a benefit, but there were issues and the benefit was small. Now twenty four years later we have got national screening for bow cancer, but it's from those from sixty to seventy five. It involves having a two sample and analyzed and the blood shows up on it. Then you get a chloscopy and it's a very effective way of finding cancers before they become symptomatic. But the issue with bow cancer, though, is that it is in the people under fifty, which it's increasing dramatically about twenty five percent per decade for those under fifty and for Mario under fifty thirty six percent, so it's quite a substantial increase this sort of response. Keeping it to older people only that sort of misses the point that the big increases in those under fifty, and that's really where we're got to be driving the screening down. And this is what's happening elsewhere in the world. New Zealand's taken a long time to get the screening. It's a very long gestation, twenty four years to spread this program, and the fact that we're not adapting to what is a huge change which is happening with bout cancer, it really seems inadequate.

Australia at that time head it down to fifty and also was possible to get it from forty five by having a discussion with your GP about the pros and cons screening and then the GP will send your name through for you to be screened if it was appropriate. Australia has subsequently moved to forty five for everyone and you can actually get it done four by having that same discussion that previously you had to have. From forty five. Australia has moved a lot. You's moved a little. Now. This is on a background to spending twenty four years introducing screening from the moment, it was from the first report saying that there would be a benefit, but there were issues and the benefit was small. Now twenty four years later we have got national screening for bow cancer, but it's from those from sixty to seventy five. It involves having a two sample and analyzed and the blood shows up on it. Then you get a chloscopy and it's a very effective way of finding cancers before they become symptomatic. But the issue with bow cancer, though, is that it is in the people under fifty, which it's increasing dramatically about twenty five percent per decade for those under fifty and for Mario under fifty thirty six percent, so it's quite a substantial increase this sort of response. Keeping it to older people only that sort of misses the point that the big increases in those under fifty, and that's really where we're got to be driving the screening down. And this is what's happening elsewhere in the world. New Zealand's taken a long time to get the screening. It's a very long gestation, twenty four years to spread this program, and the fact that we're not adapting to what is a huge change which is happening with bout cancer, it really seems inadequate.

Well you mentioned there, yeah, twenty four years of DeLay's, deferments and procrastination, and I note that you say it's led potentially to the avoidable deaths of.

Well you mentioned there, yeah, twenty four years of DeLay's, deferments and procrastination, and I note that you say it's led potentially to the avoidable deaths of.

Thousands of New Zealanders.

Thousands of New Zealanders.

As someone who's dedicated their life to preventing this disease, like yourself, This must be incredibly frustrating.

As someone who's dedicated their life to preventing this disease, like yourself, This must be incredibly frustrating.

I think it's computable that we managed. This topic was discussed in the late nineties and every reason not to do it had been put up over that period, delay after delay and excuse after excuse. Finally it was introduced, and when labor exited in national came and labor made a promised to introducing labor had to a national ended up having to adapt the same that was under the Key government. And even then they managed to drag it out by just saying I will do a national program to see if it's any different than his zend. Well, my observation of bow cancer that it looks the same inside for most people where the male female brown or white or a near huntry there prom and I've operated in lots of different countries, but if you look at it over this whole period, there would be thousands of people that have now died that would have been found with screening and that would have avoided time from the bow cancer if it had been introduced earlier.

I think it's computable that we managed. This topic was discussed in the late nineties and every reason not to do it had been put up over that period, delay after delay and excuse after excuse. Finally it was introduced, and when labor exited in national came and labor made a promised to introducing labor had to a national ended up having to adapt the same that was under the Key government. And even then they managed to drag it out by just saying I will do a national program to see if it's any different than his zend. Well, my observation of bow cancer that it looks the same inside for most people where the male female brown or white or a near huntry there prom and I've operated in lots of different countries, but if you look at it over this whole period, there would be thousands of people that have now died that would have been found with screening and that would have avoided time from the bow cancer if it had been introduced earlier.

Muori health organizations have criticized the government's revised National bowl screening program for increasing multi and Pacifica men's mortality rest what's going on there.

Muori health organizations have criticized the government's revised National bowl screening program for increasing multi and Pacifica men's mortality rest what's going on there.

Bower cancer is found at an earlier age if you look at the population of Marian Pacificame, and so it is important to drive it down for Marian Pacifica. The funding for the reduction from sixty to fifty eight, according to the minister, is coming from canceling that program and moving the funding because this is a financially neutral move what they're offering, and so canceling that doing by not duting the policy, not helping the Marian Pacifica issue, and just redirecting the money to the general population. They have argued more help more people, because of course there are more people that aren't married. There are, but it does come at a cost to a group that is already disadvantaged by a lot of issues around in society.

Bower cancer is found at an earlier age if you look at the population of Marian Pacificame, and so it is important to drive it down for Marian Pacifica. The funding for the reduction from sixty to fifty eight, according to the minister, is coming from canceling that program and moving the funding because this is a financially neutral move what they're offering, and so canceling that doing by not duting the policy, not helping the Marian Pacifica issue, and just redirecting the money to the general population. They have argued more help more people, because of course there are more people that aren't married. There are, but it does come at a cost to a group that is already disadvantaged by a lot of issues around in society.

I mean, won don't this mean that the people who are most at risk of bowel cancer are going to be left behind?

I mean, won don't this mean that the people who are most at risk of bowel cancer are going to be left behind?

Now, this will save more lives than the previous government's approach by lowering it to fifty eight for all New Zealanders. But what I can also say is we want to go further and faster as access to cholonoscopies allows us to I guess that critical will that second.

Now, this will save more lives than the previous government's approach by lowering it to fifty eight for all New Zealanders. But what I can also say is we want to go further and faster as access to cholonoscopies allows us to I guess that critical will that second.

I just want to put this to you though. This is on the Bell Cancer New Zealand website and any other number of experts you can name. They say that at present, just over half of bow cancer and mary presents before the age of sixty, whereas for non Mary it's sitting at about a third diagnosed before sixty. So that as mighty are getting it earlier, then shouldn't the screening The evidence that the Ministry of Health provided us and the analysis that was undertaken is that the age related incidence is the same based on across across different ethnicity.

I just want to put this to you though. This is on the Bell Cancer New Zealand website and any other number of experts you can name. They say that at present, just over half of bow cancer and mary presents before the age of sixty, whereas for non Mary it's sitting at about a third diagnosed before sixty. So that as mighty are getting it earlier, then shouldn't the screening The evidence that the Ministry of Health provided us and the analysis that was undertaken is that the age related incidence is the same based on across across different ethnicity.

Groups, so different the different the difference here as we have lower screening rates in those communities.

Groups, so different the different the difference here as we have lower screening rates in those communities.

Well, surely introducing a blanket policy covering all races would only make sense if we had evidence to back that up.

Well, surely introducing a blanket policy covering all races would only make sense if we had evidence to back that up.

Though right, yes, and the evidence doesn't support that. The evidence suggests Marine pacifica diagnosed later iigher rate of metastic disease. They present at a younger age and they do worse any way we look at it.

Though right, yes, and the evidence doesn't support that. The evidence suggests Marine pacifica diagnosed later iigher rate of metastic disease. They present at a younger age and they do worse any way we look at it.

I see that you have conducted research and found that there's been a significant increase in cholorectal can diagnoses among people under fifty in New Zealand, and I see further studies in Sweden and Scotland have revealed similar trends.

I see that you have conducted research and found that there's been a significant increase in cholorectal can diagnoses among people under fifty in New Zealand, and I see further studies in Sweden and Scotland have revealed similar trends.

Tell me about this, what are some of those theories.

Tell me about this, what are some of those theories.

Our cancer in New Zealand overall is actually decreasing, particularly amongst the group page fifty to eighty, the people over eighty. In New Zealand it is pretty much stable incident and those under fifty it is increasing as described before, but overall nationally it's decreasing. In Scotland it's very stable rate in bow cancer, it's not decreasing, increasing and staying the same. But we find the same observation about the rapid increase in those under fifty. In Sweden. Overall it has an increasing rate of bow cancer, and this is partly due to some of the lifestyles that people wanting to adapt, eating habits and behavior of previous generations looking back saying well we used to eat more meat, et cetera, and so they've gone in that direction. So nationally they've got an increasing rate, but the increase in those under fifty is exactly the same as in Scotland and New Zealand. So those three trees New Zealand, Scotland and Sweden all have different rates over the national total population is on decreasing, Scotland the same, Sweden increasing, and those under fifty the increase is exactly the same. So something's happening outside of something universally happening to young people, which is most likely an environmental thing, because there's no change in genes that is altering. So some behavioral thing, some adaption, that something that's going on is altering. And that here is huge implications because this increase we're seeing in young people is actually accelerating. If we break it into smaller intervals, we can see the acceleration and in fact it goes back. If we look back to the nineteen sixties, you can see the trend starting there. So something is altered. Now. There are a lot of possibilities that you know, dice change. People have more processed food, but a lot of things that we consider respects for what we call late on set normal bow cancer. For addic bow cancer is not seen in those young people, so we consider red meat, we consider smoking, We can se alcohol, lack of exercise, all issues for a beast, all issues for bow cancer and normal sporadic laid on set bowl cancer. But in young people, we know that they drink less alcohol, they smoke these cigarettes, they eat less red meat, yet they've got this big incry. So the normal whatever the normal driver is for, is not them that's doing it, and so we've got to start to think beyond that. We believe that sporadic bow cancer. So most bow cancer is sporadic. So it's just it just happens. It happens for a reason, obviously, but it's different from the people that inherit gene abnimalities or those people that have chronic infamatory conditions like colitis. Outside of that, probably eighty five percent of bow cancer at least is sporadic. It happens. That probably happens because of what you eat and the bacteria interacting in your response to that. Your bowler is lined with a protective lack of mucus. It's like a big condom that goes through your colon and protects what goes on in the middle from affecting their lining. Of about something altering. We know that the toxins made by certain bacteria, such as ZTB from PAS positive E Coli, will cause a displeasure in your colon cause pre cancer's lesions, and we've established that. We know that the normal risk factors such as red meat will make the bacteria more virulent, make them to make more toxins that we've established as well. We also know the protective things like having fireberg reen vestables will turn the toxin reduction down. So we think something's altering that model in young people. What that is, we don't know. There are many possibilities, including things like microplastics, which might well be not causing the damage themselves, not causing cancer itself, but becoming a disruptive component to altering that balance in some way, perhaps altering the muclos or protection layer. But that's where the stall where we're still researching.

Our cancer in New Zealand overall is actually decreasing, particularly amongst the group page fifty to eighty, the people over eighty. In New Zealand it is pretty much stable incident and those under fifty it is increasing as described before, but overall nationally it's decreasing. In Scotland it's very stable rate in bow cancer, it's not decreasing, increasing and staying the same. But we find the same observation about the rapid increase in those under fifty. In Sweden. Overall it has an increasing rate of bow cancer, and this is partly due to some of the lifestyles that people wanting to adapt, eating habits and behavior of previous generations looking back saying well we used to eat more meat, et cetera, and so they've gone in that direction. So nationally they've got an increasing rate, but the increase in those under fifty is exactly the same as in Scotland and New Zealand. So those three trees New Zealand, Scotland and Sweden all have different rates over the national total population is on decreasing, Scotland the same, Sweden increasing, and those under fifty the increase is exactly the same. So something's happening outside of something universally happening to young people, which is most likely an environmental thing, because there's no change in genes that is altering. So some behavioral thing, some adaption, that something that's going on is altering. And that here is huge implications because this increase we're seeing in young people is actually accelerating. If we break it into smaller intervals, we can see the acceleration and in fact it goes back. If we look back to the nineteen sixties, you can see the trend starting there. So something is altered. Now. There are a lot of possibilities that you know, dice change. People have more processed food, but a lot of things that we consider respects for what we call late on set normal bow cancer. For addic bow cancer is not seen in those young people, so we consider red meat, we consider smoking, We can se alcohol, lack of exercise, all issues for a beast, all issues for bow cancer and normal sporadic laid on set bowl cancer. But in young people, we know that they drink less alcohol, they smoke these cigarettes, they eat less red meat, yet they've got this big incry. So the normal whatever the normal driver is for, is not them that's doing it, and so we've got to start to think beyond that. We believe that sporadic bow cancer. So most bow cancer is sporadic. So it's just it just happens. It happens for a reason, obviously, but it's different from the people that inherit gene abnimalities or those people that have chronic infamatory conditions like colitis. Outside of that, probably eighty five percent of bow cancer at least is sporadic. It happens. That probably happens because of what you eat and the bacteria interacting in your response to that. Your bowler is lined with a protective lack of mucus. It's like a big condom that goes through your colon and protects what goes on in the middle from affecting their lining. Of about something altering. We know that the toxins made by certain bacteria, such as ZTB from PAS positive E Coli, will cause a displeasure in your colon cause pre cancer's lesions, and we've established that. We know that the normal risk factors such as red meat will make the bacteria more virulent, make them to make more toxins that we've established as well. We also know the protective things like having fireberg reen vestables will turn the toxin reduction down. So we think something's altering that model in young people. What that is, we don't know. There are many possibilities, including things like microplastics, which might well be not causing the damage themselves, not causing cancer itself, but becoming a disruptive component to altering that balance in some way, perhaps altering the muclos or protection layer. But that's where the stall where we're still researching.

We've seen, just looking at the numbers, the steepest rises in early bowel cancer incidents with and in Chile, New Zealand, Puerto Rico and in England. Tell me a little bit about what kind of an impact colon cancer bow cancer diagnosis has on someone.

We've seen, just looking at the numbers, the steepest rises in early bowel cancer incidents with and in Chile, New Zealand, Puerto Rico and in England. Tell me a little bit about what kind of an impact colon cancer bow cancer diagnosis has on someone.

I mean, bow.

I mean, bow.

Cancer is one of the most common types of cancer, but what's important to note here is that it's still not a common disease in younger people, so only around one in twenty vow cancer cases are in younger adults now. Of course, whatever age you are, a cancer diagnosis, it's hugely impactful and that's where research is critical. We need to go further and faster when it comes to bow cancer.

Cancer is one of the most common types of cancer, but what's important to note here is that it's still not a common disease in younger people, so only around one in twenty vow cancer cases are in younger adults now. Of course, whatever age you are, a cancer diagnosis, it's hugely impactful and that's where research is critical. We need to go further and faster when it comes to bow cancer.

When it comes to bell cancer screening, how important is it to get in early.

When it comes to bell cancer screening, how important is it to get in early.

The earlier your cancers found, the bit of you're outcome to the lower the stage. So it is very important. Particularly there are a lot of focus of bell cancer screening. Awareness is about focusing on finding cancers. It's bitter to find the lesion before cancer, a pre cancerus leason and therefore you never get cancer, and therefore it's very in cheap the treat You just need the colonost to be removed the polyp and that's so it's about driving the diagnosis of the disease as early as possible.

The earlier your cancers found, the bit of you're outcome to the lower the stage. So it is very important. Particularly there are a lot of focus of bell cancer screening. Awareness is about focusing on finding cancers. It's bitter to find the lesion before cancer, a pre cancerus leason and therefore you never get cancer, and therefore it's very in cheap the treat You just need the colonost to be removed the polyp and that's so it's about driving the diagnosis of the disease as early as possible.

Something I was wondering before while while you were talking, if you do have one of those lesions, would you know about it?

Something I was wondering before while while you were talking, if you do have one of those lesions, would you know about it?

Would you see symptoms to prompt you?

Would you see symptoms to prompt you?

If you were younger than fifty and you're not getting these regular screenings, is there something that would prompt you to go get checked out?

If you were younger than fifty and you're not getting these regular screenings, is there something that would prompt you to go get checked out?

So the symptoms that should prompt you to get checked out. Are rectal bleeding, a blood in your store or on the toilet paper, a change in your bow habit, and this may be a change in frequency or consistency of store, or the feeling that you're not quite emptying outright. These symptoms are often sort of a bit sort of tidle. You might get them for a little while, then they go away and you think, oh, that's great, I forget about it. And then they come back and you think, oh, last time they went away, and sure enough they will go away, then they'll come back. But all the time this is gradually creeping up and the cancer or whatever's causing it skin worse. The difficulty of these symptoms are very common in the community, and the younger you are, the more likely there is a benign cause for this non cancerous cause. So we know at the present time that by the time people young people under fifty percent about cancer, thirty six percent of them have got metastatic disease. Disease that is stage four. It's about trying to get that driving it down to this curable just investigating symptoms, it's we've missed the boat.

So the symptoms that should prompt you to get checked out. Are rectal bleeding, a blood in your store or on the toilet paper, a change in your bow habit, and this may be a change in frequency or consistency of store, or the feeling that you're not quite emptying outright. These symptoms are often sort of a bit sort of tidle. You might get them for a little while, then they go away and you think, oh, that's great, I forget about it. And then they come back and you think, oh, last time they went away, and sure enough they will go away, then they'll come back. But all the time this is gradually creeping up and the cancer or whatever's causing it skin worse. The difficulty of these symptoms are very common in the community, and the younger you are, the more likely there is a benign cause for this non cancerous cause. So we know at the present time that by the time people young people under fifty percent about cancer, thirty six percent of them have got metastatic disease. Disease that is stage four. It's about trying to get that driving it down to this curable just investigating symptoms, it's we've missed the boat.

So if you do go and investigate the symptoms you it's likely too late.

So if you do go and investigate the symptoms you it's likely too late.

Often thirty fix percent of the time the disease has already spread. It's not to say that the symptoms shouldn't be investigated, and they should be obviously, but the length of time it takes someone from the onset of symptoms to be diagnosed and under fifty is dramatically longer than then. It is nine times longer than it is for person who's over fifty, and that's partly the biggest actually with the patient realizing that this is not going to go away. The second lot is actually getting the doctors to do something. When you front up at forty and you've got rector bleeding, a bit of a change and power habit almost always t People will think it's probably due to the hemoids. It probably often is, but it may take two or three visits in order to initiate. And then the public system is focused on older people, so you often will get the client investigation and then if they in the can to be reason at least the Canterbury Charity Hospital will scope you and then you can get a diagnosis. But it is difficult to get investigated, difficult for patients for young people to realize that symptoms aren't no more.

Often thirty fix percent of the time the disease has already spread. It's not to say that the symptoms shouldn't be investigated, and they should be obviously, but the length of time it takes someone from the onset of symptoms to be diagnosed and under fifty is dramatically longer than then. It is nine times longer than it is for person who's over fifty, and that's partly the biggest actually with the patient realizing that this is not going to go away. The second lot is actually getting the doctors to do something. When you front up at forty and you've got rector bleeding, a bit of a change and power habit almost always t People will think it's probably due to the hemoids. It probably often is, but it may take two or three visits in order to initiate. And then the public system is focused on older people, so you often will get the client investigation and then if they in the can to be reason at least the Canterbury Charity Hospital will scope you and then you can get a diagnosis. But it is difficult to get investigated, difficult for patients for young people to realize that symptoms aren't no more.

If you could waive a magic wand Frank, what would you like to see happen tomorrow?

If you could waive a magic wand Frank, what would you like to see happen tomorrow?

I'd like the government to actually reduce the age of screening the forty five and make it possible for people to have it from forty That would be fantastic. I think even just doing what they promised would be nice, reducing it to the age of fifty.

I'd like the government to actually reduce the age of screening the forty five and make it possible for people to have it from forty That would be fantastic. I think even just doing what they promised would be nice, reducing it to the age of fifty.

How likely do you think that's going to happen?

How likely do you think that's going to happen?

Probably unlikely. There been a lot of promises and non delivery in this I don't see this government, and as you probably well aware, governments make lots of promises which they don't deliver on.

Probably unlikely. There been a lot of promises and non delivery in this I don't see this government, and as you probably well aware, governments make lots of promises which they don't deliver on.

Thanks for joining us, Frank.

Thanks for joining us, Frank.

That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzed Herald dot co dot nz. Subscribe to The Front Page on iHeartRadio or wherever you get your podcasts, and tune in tomorrow for another look behind the headlines.

That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzed Herald dot co dot nz. Subscribe to The Front Page on iHeartRadio or wherever you get your podcasts, and tune in tomorrow for another look behind the headlines.