Bowel cancer screening: the NHS finally catches up

Great news! The NHS has followed expert advice and reduced the recommended age at which to start bowel cancer screening from aged 60 to age 50.

Guess what? That is how we have worked here since I started the practice over 12 years ago.

Here at Dr Tickle, we believe in working together with you for your health. Prevention is always going to be better than cure, but one size does not fit all. Tailoring screening for harmful illnesses in a way that fits your history, genetic attributes, lifestyle risks and your views on how you would like to manage your health is key to keeping you well, physically, psychologically and financially.

To ensure that we can support you like this, I’ve spent the last 10 years studying the science behind disease prevention and the international expert panel recommendations on cancer screening.

It’s important to me that we only order tests that are safe, scientifically justified and will make a difference to the decisions you could make to enable better health in the future. It would be unethical and an abuse of your trust to do so.

Our approach to bowel cancer screening

Given our current understanding of the science, I now recommend the following:

  • Non-invasive screening for colon cancer for everyone. The test I recommend is a faecal occult blood test.
  • Start screening from aged 50 years and repeat every 12 months.
  • If one first degree relative (parent, children or siblings) or two or more second-degree relatives (grandparents, aunts and uncles) have had bowel cancer, start screening from the age at diagnosis of the youngest affected relative, minus 10 years.
  • If you have symptoms that could suggest a bowel condition, such as abdominal pains, change in digestive habits, diarrhoea, increased frequency of needing the toilet or blood/mucous in the excreta, then screening is not where you need to be. These symptoms need a prompt appointment for formal investigations with a specialist colleague, a gastroenterologist.

To discuss our bowel cancer screening further, call us on 07788797824.

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Screening for cervical cancer

There have recently been changes in how we use tests for cervical cancer screening. The new testing regime is safer and more reliable, which has simplified the diagnostic pathways and strategies we need to follow if you are found to have any abnormal results.

Why have changes been made to cervical cancer screening?

Over the last 20 years, it has become clear that pre-cancerous changes in the cells of the cervix are provoked by persistent Human Papilloma Virus (HPV) infection. So far as we can tell, there are no other causes. Now that we know this, we have discovered that it is much easier to test samples for HPV than it is to analyse cell samples under a microscope. The process is faster, more efficient, less prone to error and cheaper than the previous tests.

Human Papilloma Virus

Hang on – what is HPV?

Human Papilloma Virus (HPV) is best considered as ubiquitous, as all human beings carry one or more of these viruses on their person at any one time. Although this sounds scary, there are not usually any problems from this, as the skin cells and the multitude of friendly germs which cover us prevent the virus from harming us. From time to time, this first line immune defence can fail; when this happens on our outsides, we might develop warts or verrucas (which are warts on the sole of the foot).

HPV and cancer

Unfortunately, as the softer membranes of the body are not as robust as the skin cells on our outside, it can be easier for these cells to become infected by HPV. Usually, these infections are transient, and the immune system clears these without any assistance within a number or months; certainly, the clearance rate by 12 months is around 90%. In the remainder of cases, the affected cells might become disorganised and deregulated, where upon the cells become pre-cancerous. We have associated HPV infection with soft tissue cancers in the cervix, throat, anus, rectum and oesophagus. We expect that rates of these cancers will fall, as the impact of vaccinating younger people against HPV infection becomes apparent. The data on this is already quite encouraging, even after only 12 years of the programme.

What has not changed?

  • Cervical smears are still recommended from age 25 until the age of 64, ideally every 2-3 years.
  • The method for taking the sample has not changed – you will still require speculum examination by you Dr or nurse.
  • If we find HPV positive samples, the laboratory technicians can then undertake analysis of the cells, but only if the cervix has been sampled properly by passing a speculum, directly visualising the cervix and taking samples directly from those cells.

What has changed?

The only difference from your perspective will be the way in which results are reported after your smear. These will now show as either HPV negative, which put bluntly means there is no risk of developing precancerous changes, or HPV positive.

HPV positive DOES NOT equate to cancer, or even pre-cancerous changes. If your sample is HPV positive, the virus type(s) present will be identified as low or high-risk strains. It is only the high-risk strains that are problematic from a cancer-causing perspective. The HPV positive samples showing high-risk strains are then further processed, to analyse the cells, as previously happened for all samples. Depending on this result, you may be recommended to take further tests.

Cervical Cells

Vaccinations against HPV

Vaccinations against HPV have been available since around 2007. The UK government adopted a policy to vaccinate youngsters around the age of 12-13 against HPV. For the first 10 years of the national program, only girls were vaccinated, although this has been addressed and all children are now offered vaccination.

Gardasil ™ has been formulated to protect against the 9 most frequent high-risk strains of HPV. It is a well-tolerated vaccination and I fully recommend this for young people, preferably before likely sexual exposure to HPV has occurred. The national programme holds that vaccination is appropriate between ages of 12 and 13; however, the vaccination is licensed until aged 26 and it is even sensible to consider vaccination in older age groups on a case by case basis. The currently recommended course to achieve immunity is 2 shots if you are under the age of 14 or 3 shots if you are older than 14.

How we can help you at Dr Tickle

We will offer you smear appointments every 2 years; these dates will be kept in our diary reminders on your file so that we can help you to stay on top of this.

We offer vaccination against HPV – this is a course of two vaccinations, 6-12 months apart, which offers cover against 9 of the high-risk strains of HPV.

We are able to vaccinate young men and boys who have been excluded by the NHS so far; if you have sons, grandsons or nephews between the ages of 15 and 24 who would like to be vaccinated, we are able to offer this.

Should you have received a positive HPV result and this is causing you concern, we have longer appointments to discuss the implications of this and the next steps to resolve this issue.

Dr Tickle take-home message:

  • Smears are available at this clinic and are now cheaper and more efficient than they were before.
  • Unless there is a strong indication, such as family history or large number of sexual partners, cervical screening is recommended at a 2-3 year interval from aged 25 to aged 50, thereafter every 5 years.
  • HPV positivity does not equate to cancer. Keep calm – come see Dr Tickle.

Call 07788797824 to arrange an appointment at our private London GP clinic.

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How do I choose a knee surgeon? Our guide to choosing an orthopaedic specialist

In addition to the clinical knowledge updates that are undertaken regularly, I also spend time every year considering to whom you should be referred should this be required. As you can imagine, in medicine there are often changes, an inevitable result of scientific evidence evolving and leading to new and improved best practice guidelines and advances in treatment options. In many surgical specialties, safety and outcome data are now routinely available. We should be using these resources to make good decisions together.

Orthopaedic Care

1 in 2 of us will eventually consider a joint replacement

I know that a lot of us develop significant aches and pains as we grow older, be that related to injury, ongoing osteoarthritis or other factors,@ and, as a result, some of us will eventually consider joint replacement surgery. Within the next 30 years, this may well be one in two people. Naturally, as this is a common problem, we have hordes of orthopaedic surgeons in private practice in the locale, so what is important in how we choose the specialist you would most benefit from?

How to choose an orthopaedic surgeon?

If I needed a replacement joint, I would want to know that the following bases are covered:

  • Does the surgeon perform a sufficient quantity of this type of surgery to be any good at it?
  • Are the surgeon’s outcome data available to review and is the surgeon happy to discuss?
  • Are the anaesthetists good at the hospital you will be admitted to?
  • What happens if things go wrong? Both in the short term – you are ill immediately after your surgery, or in the longer term if your joint does not recover as expected?
  • What is the post-operative journey like? How quickly will you approach your recovery, how soon will you be home and what
  • is the post-operative infection rate, does your rehabilitation plan fit you and is it included as part of your care package?
  • Will your insurance provider meet the costs involved?

What does this mean in practice?

Taking all of this into account, I am planning to send more of the orthopaedic referrals I make to the Schoen Clinic, as this clinic is set up to meet all of these ends and, most importantly, they have good checks and systems to ensure they are doing as well as they say that they are.

Safety is top of the agenda in this hospital, so much so that the ward doctors are all consultant anaesthetists who are specialised in ITU level care. This means that any peri-operative difficulties or complications can be spotted quickly and dealt with effectively.

Please note, this decision is based on overall outcomes, all data available in the public domain and I’ve also done a review of safety procedures in this modern, specialised orthopaedic hospital. This is by no means a commentary on the scope of practice or the ability of any of the other surgeons to whom I refer, nor a reflection on the safety or procedures of other hospitals in this area.

As I move through the clinical specialties, there will be more to follow on how I help you to make these decisions. All questions welcome at any stage.

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