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Oesophgeal Cancer – ignored but on the increase

As we emerged, bleary eyed into 2016 we faced what can only be described as ‘cancer month’. Those who weren’t giving up the demon drink to raise funds for the prevention of it were making resolutions to make changes in avoidance of it and those doing neither were repeatedly assailed by news of heroes and idols carried off by it.

It’s big business for anyone who hasn’t noticed with helpful messages of hope and triumph beaten to a pulp by billboards and adverts proclaiming its seeming inevitability. Does the spirit of hope and human endeavour lie somewhere between that carrot and stick? If we raise awareness by grabbing people by the lapels are we frightening as many into denial as we are encouraging into healthier lifestyles?

The truth about cancer is the very worst type is the one your loved one has, or the one to which you lost someone dear. It is understandably expedient for Governments to prioritise some, to tackle outcomes by herding commonality into the same side of the lab. It delivers fiscally prudent results and it must feel like a small victory for the chosen few who ascend cancer’s Mount Olympus to be screened, consulted, debated and prioritised.

For those left struggling to comprehend suffering, loss and death from a cancer they have never heard of, consolation is a faraway land. Helping grief stricken families comprehend the speed and scale of their loss in a seeming desert of information is humbling. Oesophageal cancer is the fifth most common cause of cancer death in Scotland but no one is talking about it.

Sufferers and their families want to know why no one seems to be doing anything to tell people about it. Why doctors failed to refer them, why screening came too late for treatment, why so few treatment options exist. We can tell them of the work that goes on, the research and the campaigning, the diligent cooperation with others in the same field but ultimately they feel scorned. They weep when they find out that perpetual heartburn was a danger sign. They ask why they were able to keep buying heartburn remedies and no one ever asked why. They still wonder if they had made more of a fuss when swallowing became difficult if the outcome would have been different. But most of all they cannot understand why an entire cancer is being ignored.

Scotland has around 1000 cases of oesophageal cancer per year. Survival is poor with only 15% of those diagnosed surviving after five years. This is because it is so often diagnosed too late for the patient to be considered for potentially curative treatment like surgery.

Persistent or regular heartburn can change the cells in the lining of the oesophagus becoming Barrett’s Oesophagus, a cancer precursor affecting approximately 7% of the population.  Those diagnosed with Barrett’s Oesophagus are around 30 times more likely to go on to develop oesophageal cancer compared to non-Barrett’s patients. Evidence suggests this incidence has increased significantly over the past 10 to 20 years and that almost 25% of Barrett’s Oesophagus patients will die of oesophageal cancer. To add insult to injury those in the west of Scotland yet again bear the brunt of consistently negative statistics. Overall oesophageal cancer is significantly higher in the West of Scotland, higher than the rest of Scotland, UK and around five times higher than of a similar sized country like Denmark. As is often the case, clinicians are unsure as to why this is the case but it certainly adds support to a campaign for helping people understand that heartburn isn’t OK, it isn’t ‘normal for me’, you are not ‘just an acid-y sort of person’. Find out what is causing your heartburn. Make a doctor’s appointment, if you are worried, keep going back.

It might not be on the Government’s battle ready list of cancer priorities but many Scots have heard of it on the worst days of their lives. Oesophageal cancer. Hold the coats, Scotland, we are up for this fight. Ready or not.

 Kate Cunningham

The Herald, page 15, 26 February 2016

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