Health: Vital Signs - Embarrassing evidence

Embarrassment can be a fatal condition. In the case of cancer of the bowel, the second biggest cancer killer, there is evidence that embarrassment is sending thousands of patients to unnecessary deaths, covering up low standards and keeping the cancer out of the public eye.

Cure rates for bowel cancer vary widely between hospitals and between surgeons, and lives could be saved if treatment were concentrated in the hands of the best, according to new guidelines issued by the health department.

Bowel cancer killed over 17,500 people in 1996 but, unlike most common cancers, is completely curable if caught early. Its curability is linked to the fact that it remains localised until relatively advanced. If the cancer is removed completely there is a good chance it will not recur. However, only a minority of patients get ideal treatment.

Diagnosis is frequently delayed because patients are embarrassed to consult their GPs about the early signs, such as blood in the faeces. Most who need surgery are operated on by general surgeons who do not have the specialist skills necessary to ensure all the cancer is removed.

The guidance, sent to all GPs, Health Authorities and NHS Trusts, says studies in Scotland show that survival after five years varies from 20 per cent to 60 per cent depending on the surgeon carrying out the operation. One hospital had twice the failure rate of others. The low overall survival rate is linked with the advanced stage of the cancers at diagnosis.

It says surgery should be restricted to those surgeons who show good results with low recurrence rates. The best results, which halve the risk of the cancer recurring, are achieved by a complex operation involving meticulous dissection of the tissues surrounding the rectum. Known as Total Mesorectal Excision (TME) it requires specialist training and is currently carried out by only a "limited number of surgeons".

Radiotherapy given before surgery reduces recurrence rates by up to 40 per cent but patients who get radiotherapy tend to have it after surgery when it is less effective, lasts longer and causes more damage to other tissues. Chemotherapy increases survival by 6 per cent.

The guidance is based on a review of research by the NHS Centre for Reviews and Dissemination at the University of York. Arabella Melville, chief author of the review, said: "The variations in treatment are much more serious with this cancer than with others. But it doesn't have a high profile. It is not something people want to know about. Thousands of lives could be saved every year by following this guidance."