Questions over access and accuracy of bowel screening are left being asked after the stage four bowel cancer diagnosis of Paul Cosgrove, a 64-year old Wānaka man that was denied a colonoscopy despite persistent bowel pain and a noted high risk of cancer. Bowel screening kits are sent to homes for people between the ages of 60-74 to detect traces of blood in faeces; if the level is high enough then the patient is referred to a colonoscopy to examine the colon for cancer. 

For every year in the past four years, 85 percent of symptomatic referrals for colonoscopy have been accepted at Southern DHB, however this leaves 25 percent of referrals still in question. Dr Jason Hill, gastroenterology consultant, says that in 15 percent of cases an alternative intervention is deemed more appropriate by specialists, such as outpatient specialist assessment and radiological evaluation, whilst the remaining minority there is insufficient information from the referrer. 

In the case of Paul Cosgrove, Hill said, “In the event that a referral is not immediately accepted, the affected individual and the referrer would be advised to understand the reasons for this and develop a ‘safety net’ strategy so that any misunderstandings, or changes in clinical situation, can be identified and communicated as early as possible.” Referral rates aside, even screening processes for bowel cancer have come under criticism by University of Otago academics by for being too simplistic in their negative/positive approach to testing. The cut off for a positive screening result is 200ng of haemoglobin, yet a Waitemata pilot study found 17 percent of all bowel cancer sufferers had a reading of 75ng or below. Hill explains that district health boards have no mandate to change parameters and processes, but notes that the qualifying positive result was chosen to “maximise screening opportunities for New Zealanders, without impacting significantly on current service delivery, as well as reducing the number of invasive investigations (and complications) in individuals who have been shown to be at a much lower risk of having bowel cancer.” 

The number of cancer-related compensation payouts, due to misdiagnosis or slow diagnoses, has increased from five in 2012/13 to 113 in 2017/18, however, since the inception of the Southern DHB’s Bowel Screening more than a 100 cases of cancer have been detected, so positives remain to be seen. Wānaka residents shouldn’t worry too much, as Hill says that “The current wait time for colonoscopy in the Programme (for those testing positive) is no different for Wānaka residents compared to any other area in the Southern district.”