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Speaker 1: Kiaoda.

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Speaker 2: I'm Chelsea Daniels and this is the Front Page, a

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Speaker 2: daily podcast presented by the New Zealand Herald. Bowel cancer

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Speaker 2: is the second highest cause of cancer death in New Zealand.

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Speaker 2: One in ten Kiwis diagnosed are under fifty, and every

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Speaker 2: day around three New Zealanders die from bow cancer. Now

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Speaker 2: keep those figures in mind when I tell you that

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Speaker 2: Health Minister Simeon Brown has announced the government is lowering

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Speaker 2: the screening from sixty to fifty eight for all Kiwis

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Speaker 2: and canned plans to lower the age for Maldi and

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Speaker 2: Pacific men to fifty. That might be a good fit

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Speaker 2: for the Pakiha majority, but less so for Maldi and Pacific,

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Speaker 2: given more of those groups developed cancer earlier. For example,

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Speaker 2: about twenty six percent of bowel cancers and Pacific peoples

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Speaker 2: occur between fifty and fifty nine years old, compared to

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Speaker 2: about eleven percent for non multi or Pacific populations. Today

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Speaker 2: on the front page, University of the Targo professor of

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Speaker 2: colorectal surgery, Frank Brazell joins us to discuss what needs

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Speaker 2: to be done to prevent this disease. Frank, you wrote

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Speaker 2: a pretty scathing editorial in the latest issue of the

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Speaker 2: New Zealand Medical Journal, tell me about it.

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Speaker 3: The Ministry Health on the sixth to March announced the

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Speaker 3: changes to the bow screening and has reduced it from

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Speaker 3: sixty to fifty eight. This seems to be the least

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Speaker 3: possible that he can do. When the Prime Minister in

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Speaker 3: the pre election TV interviews, when they have those leader's debates,

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Speaker 3: it's said they were reduced to the same as Australia.

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Speaker 4: Sitting our audience right up there is Amy Rose Yates.

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Speaker 4: She's got stage four terminal bowl cancer and she's in

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Speaker 4: her early thirties. The national age for screening in this

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Speaker 4: country is sixty. Her question is will either of you

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Speaker 4: lower the age of screening and save the lives of Kiwis?

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Speaker 5: Yeah, I'd like to do that, and we've also said

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Speaker 5: we'd like to do it. On breast cancer screening, we're

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Speaker 5: extending it from sixty nine to seventy four. Saving sixty

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Speaker 5: five lives makes sense that we should do the same

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Speaker 5: on bell cancer.

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Speaker 4: So what will you bring it?

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Speaker 5: Because lady, here's the problem, right, we have a fifteen

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Speaker 5: percent higher mortality rate on cancer than the equivalents in Australia. Do,

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Speaker 5: and so we actually have to close that cancer gap

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Speaker 5: big time.

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Speaker 4: Okay, so the bowel cancer screen do you want to

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Speaker 4: bring it down as well? Chris sippins, Well, yes, absolutely

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Speaker 4: I do, so you'll make that commitment to bring it

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Speaker 4: down absolutely now.

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Speaker 3: Australia at that time head it down to fifty and

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Speaker 3: also was possible to get it from forty five by

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Speaker 3: having a discussion with your GP about the pros and

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Speaker 3: cons screening and then the GP will send your name

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Speaker 3: through for you to be screened if it was appropriate.

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Speaker 3: Australia has subsequently moved to forty five for everyone and

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Speaker 3: you can actually get it done four by having that

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Speaker 3: same discussion that previously you had to have. From forty five.

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Speaker 3: Australia has moved a lot. You's moved a little. Now.

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Speaker 3: This is on a background to spending twenty four years

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Speaker 3: introducing screening from the moment, it was from the first

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Speaker 3: report saying that there would be a benefit, but there

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Speaker 3: were issues and the benefit was small. Now twenty four

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Speaker 3: years later we have got national screening for bow cancer,

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Speaker 3: but it's from those from sixty to seventy five. It

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Speaker 3: involves having a two sample and analyzed and the blood

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Speaker 3: shows up on it. Then you get a chloscopy and

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Speaker 3: it's a very effective way of finding cancers before they

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Speaker 3: become symptomatic. But the issue with bow cancer, though, is

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Speaker 3: that it is in the people under fifty, which it's

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Speaker 3: increasing dramatically about twenty five percent per decade for those

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Speaker 3: under fifty and for Mario under fifty thirty six percent,

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Speaker 3: so it's quite a substantial increase this sort of response.

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Speaker 3: Keeping it to older people only that sort of misses

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Speaker 3: the point that the big increases in those under fifty,

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Speaker 3: and that's really where we're got to be driving the

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Speaker 3: screening down. And this is what's happening elsewhere in the world.

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Speaker 3: New Zealand's taken a long time to get the screening.

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Speaker 3: It's a very long gestation, twenty four years to spread

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Speaker 3: this program, and the fact that we're not adapting to

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Speaker 3: what is a huge change which is happening with bout cancer,

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Speaker 3: it really seems inadequate.

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Speaker 2: Well you mentioned there, yeah, twenty four years of DeLay's,

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Speaker 2: deferments and procrastination, and I note that you say it's

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Speaker 2: led potentially to the avoidable deaths of.

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Speaker 1: Thousands of New Zealanders.

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Speaker 2: As someone who's dedicated their life to preventing this disease,

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Speaker 2: like yourself, This must be incredibly frustrating.

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Speaker 3: I think it's computable that we managed. This topic was

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Speaker 3: discussed in the late nineties and every reason not to

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Speaker 3: do it had been put up over that period, delay

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Speaker 3: after delay and excuse after excuse. Finally it was introduced,

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Speaker 3: and when labor exited in national came and labor made

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Speaker 3: a promised to introducing labor had to a national ended

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Speaker 3: up having to adapt the same that was under the

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Speaker 3: Key government. And even then they managed to drag it

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Speaker 3: out by just saying I will do a national program

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Speaker 3: to see if it's any different than his zend. Well,

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Speaker 3: my observation of bow cancer that it looks the same

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Speaker 3: inside for most people where the male female brown or

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Speaker 3: white or a near huntry there prom and I've operated

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Speaker 3: in lots of different countries, but if you look at

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Speaker 3: it over this whole period, there would be thousands of

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Speaker 3: people that have now died that would have been found

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Speaker 3: with screening and that would have avoided time from the

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Speaker 3: bow cancer if it had been introduced earlier.

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Speaker 2: Muori health organizations have criticized the government's revised National bowl

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Speaker 2: screening program for increasing multi and Pacifica men's mortality rest

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Speaker 2: what's going on there.

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Speaker 3: Bower cancer is found at an earlier age if you

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Speaker 3: look at the population of Marian Pacificame, and so it

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Speaker 3: is important to drive it down for Marian Pacifica. The

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Speaker 3: funding for the reduction from sixty to fifty eight, according

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Speaker 3: to the minister, is coming from canceling that program and

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Speaker 3: moving the funding because this is a financially neutral move

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Speaker 3: what they're offering, and so canceling that doing by not

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Speaker 3: duting the policy, not helping the Marian Pacifica issue, and

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Speaker 3: just redirecting the money to the general population. They have

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Speaker 3: argued more help more people, because of course there are

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Speaker 3: more people that aren't married. There are, but it does

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Speaker 3: come at a cost to a group that is already

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Speaker 3: disadvantaged by a lot of issues around in society.

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Speaker 6: I mean, won don't this mean that the people who

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Speaker 6: are most at risk of bowel cancer are going to

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Speaker 6: be left behind?

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Speaker 7: Now, this will save more lives than the previous government's

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Speaker 7: approach by lowering it to fifty eight for all New Zealanders.

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Speaker 7: But what I can also say is we want to

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Speaker 7: go further and faster as access to cholonoscopies allows us

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Speaker 7: to I guess that critical will that second.

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Speaker 6: I just want to put this to you though. This

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Speaker 6: is on the Bell Cancer New Zealand website and any

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Speaker 6: other number of experts you can name. They say that

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Speaker 6: at present, just over half of bow cancer and mary

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Speaker 6: presents before the age of sixty, whereas for non Mary

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Speaker 6: it's sitting at about a third diagnosed before sixty. So

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Speaker 6: that as mighty are getting it earlier, then shouldn't the

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Speaker 6: screening The evidence that the Ministry of Health provided us

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Speaker 6: and the analysis that was undertaken is that the age

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Speaker 6: related incidence is the same based on across across different ethnicity.

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Speaker 7: Groups, so different the different the difference here as we

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Speaker 7: have lower screening rates in those communities.

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Speaker 2: Well, surely introducing a blanket policy covering all races would

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Speaker 2: only make sense if we had evidence to back that up.

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Speaker 3: Though right, yes, and the evidence doesn't support that. The

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Speaker 3: evidence suggests Marine pacifica diagnosed later iigher rate of metastic disease.

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Speaker 3: They present at a younger age and they do worse

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Speaker 3: any way we look at it.

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Speaker 2: I see that you have conducted research and found that

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Speaker 2: there's been a significant increase in cholorectal can diagnoses among

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Speaker 2: people under fifty in New Zealand, and I see further

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Speaker 2: studies in Sweden and Scotland have revealed similar trends.

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Speaker 1: Tell me about this, what are some of those theories.

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Speaker 3: Our cancer in New Zealand overall is actually decreasing, particularly

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Speaker 3: amongst the group page fifty to eighty, the people over eighty.

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Speaker 3: In New Zealand it is pretty much stable incident and

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Speaker 3: those under fifty it is increasing as described before, but

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Speaker 3: overall nationally it's decreasing. In Scotland it's very stable rate

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Speaker 3: in bow cancer, it's not decreasing, increasing and staying the same.

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Speaker 3: But we find the same observation about the rapid increase

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Speaker 3: in those under fifty. In Sweden. Overall it has an

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Speaker 3: increasing rate of bow cancer, and this is partly due

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Speaker 3: to some of the lifestyles that people wanting to adapt,

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Speaker 3: eating habits and behavior of previous generations looking back saying

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Speaker 3: well we used to eat more meat, et cetera, and

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Speaker 3: so they've gone in that direction. So nationally they've got

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Speaker 3: an increasing rate, but the increase in those under fifty

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Speaker 3: is exactly the same as in Scotland and New Zealand.

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Speaker 3: So those three trees New Zealand, Scotland and Sweden all

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Speaker 3: have different rates over the national total population is on decreasing,

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Speaker 3: Scotland the same, Sweden increasing, and those under fifty the

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Speaker 3: increase is exactly the same. So something's happening outside of

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Speaker 3: something universally happening to young people, which is most likely

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Speaker 3: an environmental thing, because there's no change in genes that

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Speaker 3: is altering. So some behavioral thing, some adaption, that something

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Speaker 3: that's going on is altering. And that here is huge

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Speaker 3: implications because this increase we're seeing in young people is

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Speaker 3: actually accelerating. If we break it into smaller intervals, we

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Speaker 3: can see the acceleration and in fact it goes back.

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Speaker 3: If we look back to the nineteen sixties, you can

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Speaker 3: see the trend starting there. So something is altered. Now.

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Speaker 3: There are a lot of possibilities that you know, dice change.

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Speaker 3: People have more processed food, but a lot of things

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Speaker 3: that we consider respects for what we call late on

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Speaker 3: set normal bow cancer. For addic bow cancer is not

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Speaker 3: seen in those young people, so we consider red meat,

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Speaker 3: we consider smoking, We can se alcohol, lack of exercise,

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Speaker 3: all issues for a beast, all issues for bow cancer

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Speaker 3: and normal sporadic laid on set bowl cancer. But in

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Speaker 3: young people, we know that they drink less alcohol, they

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Speaker 3: smoke these cigarettes, they eat less red meat, yet they've

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Speaker 3: got this big incry. So the normal whatever the normal

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Speaker 3: driver is for, is not them that's doing it, and

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Speaker 3: so we've got to start to think beyond that. We

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Speaker 3: believe that sporadic bow cancer. So most bow cancer is sporadic.

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Speaker 3: So it's just it just happens. It happens for a reason, obviously,

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Speaker 3: but it's different from the people that inherit gene abnimalities

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Speaker 3: or those people that have chronic infamatory conditions like colitis.

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Speaker 3: Outside of that, probably eighty five percent of bow cancer

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Speaker 3: at least is sporadic. It happens. That probably happens because

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Speaker 3: of what you eat and the bacteria interacting in your

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Speaker 3: response to that. Your bowler is lined with a protective

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Speaker 3: lack of mucus. It's like a big condom that goes

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Speaker 3: through your colon and protects what goes on in the

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Speaker 3: middle from affecting their lining. Of about something altering. We

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Speaker 3: know that the toxins made by certain bacteria, such as

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Speaker 3: ZTB from PAS positive E Coli, will cause a displeasure

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Speaker 3: in your colon cause pre cancer's lesions, and we've established that.

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Speaker 3: We know that the normal risk factors such as red

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Speaker 3: meat will make the bacteria more virulent, make them to

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Speaker 3: make more toxins that we've established as well. We also

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Speaker 3: know the protective things like having fireberg reen vestables will

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Speaker 3: turn the toxin reduction down. So we think something's altering

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Speaker 3: that model in young people. What that is, we don't know.

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Speaker 3: There are many possibilities, including things like microplastics, which might

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Speaker 3: well be not causing the damage themselves, not causing cancer itself,

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Speaker 3: but becoming a disruptive component to altering that balance in

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Speaker 3: some way, perhaps altering the muclos or protection layer. But

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Speaker 3: that's where the stall where we're still researching.

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Speaker 8: We've seen, just looking at the numbers, the steepest rises

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Speaker 8: in early bowel cancer incidents with and in Chile, New Zealand,

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Speaker 8: Puerto Rico and in England. Tell me a little bit

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Speaker 8: about what kind of an impact colon cancer bow cancer

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Speaker 8: diagnosis has on someone.

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Speaker 6: I mean, bow.

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Speaker 9: Cancer is one of the most common types of cancer,

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Speaker 9: but what's important to note here is that it's still

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Speaker 9: not a common disease in younger people, so only around

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Speaker 9: one in twenty vow cancer cases are in younger adults now.

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Speaker 9: Of course, whatever age you are, a cancer diagnosis, it's

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Speaker 9: hugely impactful and that's where research is critical. We need

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Speaker 9: to go further and faster when it comes to bow cancer.

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Speaker 2: When it comes to bell cancer screening, how important is

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Speaker 2: it to get in early.

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Speaker 3: The earlier your cancers found, the bit of you're outcome

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Speaker 3: to the lower the stage. So it is very important.

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Speaker 3: Particularly there are a lot of focus of bell cancer screening.

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Speaker 3: Awareness is about focusing on finding cancers. It's bitter to

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Speaker 3: find the lesion before cancer, a pre cancerus leason and

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Speaker 3: therefore you never get cancer, and therefore it's very in

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Speaker 3: cheap the treat You just need the colonost to be

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Speaker 3: removed the polyp and that's so it's about driving the

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Speaker 3: diagnosis of the disease as early as possible.

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Speaker 2: Something I was wondering before while while you were talking,

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Speaker 2: if you do have one of those lesions, would you

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Speaker 2: know about it?

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Speaker 1: Would you see symptoms to prompt you?

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Speaker 2: If you were younger than fifty and you're not getting

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Speaker 2: these regular screenings, is there something that would prompt you

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Speaker 2: to go get checked out?

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Speaker 3: So the symptoms that should prompt you to get checked out.

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Speaker 3: Are rectal bleeding, a blood in your store or on

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Speaker 3: the toilet paper, a change in your bow habit, and

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Speaker 3: this may be a change in frequency or consistency of store,

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Speaker 3: or the feeling that you're not quite emptying outright. These

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Speaker 3: symptoms are often sort of a bit sort of tidle.

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Speaker 3: You might get them for a little while, then they

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Speaker 3: go away and you think, oh, that's great, I forget

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Speaker 3: about it. And then they come back and you think, oh,

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Speaker 3: last time they went away, and sure enough they will

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Speaker 3: go away, then they'll come back. But all the time

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Speaker 3: this is gradually creeping up and the cancer or whatever's

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Speaker 3: causing it skin worse. The difficulty of these symptoms are

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Speaker 3: very common in the community, and the younger you are,

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Speaker 3: the more likely there is a benign cause for this

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Speaker 3: non cancerous cause. So we know at the present time

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Speaker 3: that by the time people young people under fifty percent

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Speaker 3: about cancer, thirty six percent of them have got metastatic disease.

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Speaker 3: Disease that is stage four. It's about trying to get

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Speaker 3: that driving it down to this curable just investigating symptoms,

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Speaker 3: it's we've missed the boat.

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Speaker 2: So if you do go and investigate the symptoms you

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Speaker 2: it's likely too late.

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Speaker 3: Often thirty fix percent of the time the disease has

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Speaker 3: already spread. It's not to say that the symptoms shouldn't

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Speaker 3: be investigated, and they should be obviously, but the length

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Speaker 3: of time it takes someone from the onset of symptoms

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Speaker 3: to be diagnosed and under fifty is dramatically longer than then.

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Speaker 3: It is nine times longer than it is for person

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Speaker 3: who's over fifty, and that's partly the biggest actually with

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Speaker 3: the patient realizing that this is not going to go away.

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Speaker 3: The second lot is actually getting the doctors to do something.

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Speaker 3: When you front up at forty and you've got rector bleeding,

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Speaker 3: a bit of a change and power habit almost always

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Speaker 3: t People will think it's probably due to the hemoids.

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Speaker 3: It probably often is, but it may take two or

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Speaker 3: three visits in order to initiate. And then the public

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Speaker 3: system is focused on older people, so you often will

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Speaker 3: get the client investigation and then if they in the

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Speaker 3: can to be reason at least the Canterbury Charity Hospital

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Speaker 3: will scope you and then you can get a diagnosis.

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Speaker 3: But it is difficult to get investigated, difficult for patients

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Speaker 3: for young people to realize that symptoms aren't no more.

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Speaker 2: If you could waive a magic wand Frank, what would

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Speaker 2: you like to see happen tomorrow?

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Speaker 3: I'd like the government to actually reduce the age of

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Speaker 3: screening the forty five and make it possible for people

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Speaker 3: to have it from forty That would be fantastic. I

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Speaker 3: think even just doing what they promised would be nice,

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Speaker 3: reducing it to the age of fifty.

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Speaker 1: How likely do you think that's going to happen?

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Speaker 3: Probably unlikely. There been a lot of promises and non

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Speaker 3: delivery in this I don't see this government, and as

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Speaker 3: you probably well aware, governments make lots of promises which

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Speaker 3: they don't deliver on.

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Speaker 1: Thanks for joining us, Frank.

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Speaker 2: That's it for this episode of the Front Page. You

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Speaker 2: can read more about today's stories and extensive news coverage

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Speaker 2: at enzed Herald dot co dot nz. Subscribe to The

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Speaker 2: Front Page on iHeartRadio or wherever you get your podcasts,

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Speaker 2: and tune in tomorrow for another look behind the headlines.