Countywide screening for bowel cancer:

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1 Countywide screening for bowel cancer: How to take the test Bowel cancer screening Copenhagen County and the Danish Cancer Society are currently offering half of the county s residents between 50 and 74 years old an opportunity to be screened for bowel cancer (colorectal cancer). You are among those invited to take the screening test. In Denmark alone, 3500 people a year develop cancer of the colon or rectum. Bowel cancer is one of the types of cancer most widespread in the population. Taking the test reveals whether or not you have hidden blood in your stool, which is one of the first signs of bowel cancer. You cannot see it or tell whether it is there; only a test can reveal it. The earlier bowel cancer is discovered, the greater the chances it can be cured. That is why it is vital to be tested. Usually, bowel cancer is not discovered until people go to their doctor because they think something is wrong with their stomach or stool. By then they may already have had cancer for a long time. You have to take the samples for the test yourself. Together with this brochure, you received a test kit to be used in taking samples of your stool. This brochure also tells you how to take the test. What is cancer, and who develops it? Cancer is an illness that starts with a tumour somewhere in the body, e.g. in the colon. If cancer is not treated, it destroys our body s organs and spreads to other parts of the body. Some people die from cancer, but not everyone. People all over the world develop cancer. Causes of bowel cancer We do not know why some people develop bowel cancer. However, several studies show that diet plays a role. Countywide screening for bowel cancer (Engelsk) 1

2 How to take the test Read the instructions thoroughly before taking samples for the test Separate the test kit and the storage bag. Rip the top off the testing kit package. The test kit consists of three test cards and six pieces of cardboard. The instructions in the test kit bag are out of date, so please throw them away. 2. Take a sticker with a barcode and CPR number off the letter Put the sticker onto one of the test cards so that it covers the large printing that says Hemoccult. Write the date on which you have taken the samples on the test card. 4. Open the test card right under the sticker and date Stick the collection paper onto the toilet seat. You can also use a different method to collect your samples, but the stool must not come into contact with the water in the toilet or any chemicals. 6. Use a piece of cardboard to take a sample of stool the size of a pea. Smear the stool onto the test card in a thin layer so that it covers the part of the test card marked A. Throw the piece of cardboard away. 7. Take a new sample from another spot in the stool using a clean piece of cardboard and smear a thin layer onto the part of the test card labelled B. 8. Close the test card and put it in the storage bag. Do not close the bag: the sample is supposed to dry out. While they are drying, do not expose the samples on the test card to direct sunlight or cold temperatures (below 15 degrees Celsius). Repeat steps 1-8 two more days within a total period of ten days: three days in a row is fine, but not necessary. Once you have taken all three sets of samples, check to make sure that there is a sticker with a bar code, CPR number and date on all three test cards. Put the test cards into the storage bag, close it and send it in the blue reply envelope supplied. Countywide screening for bowel cancer (Engelsk) 2

3 Before and while you are taking the samples The three days before you take the first day samples and until you have taken the third test do not eat meat that is not well done, i.e. cooked all the way through. eat or drink more than 250 mg vitamin C (ascorbic acid) a day, e.g. from vitamin pills, citrus fruit or juice. One orange contains 75 mg vitamin C and a glass of orange juice 60 mg vitamin C. Do not take the test if your stool came into contact with the water in the toilet. you are having your menstruation. You must wait at least three days after the last day of your period before you take the test. Contact your doctor before you take the test if there is visible blood in your stool. there is visible blood in your urine. you are in doubt about whether you can take part in the screening test. You should always go to your doctor if you see blood or mucous in your stool or if you have a persistent change in bowel habits, even if you just recently had a check-up or were tested. Test results You will receive the test result by post not more than 14 days after you sent the samples. Unfortunately, we are unable to send the test result in English; the result will be in Danish. If you need help in understanding the test result, please telephone Kræftlinien (the Cancer Hotline) on for help in English. You can call this number Tuesdays or Thursdays between 9 am and 9 pm. Countywide screening for bowel cancer (Engelsk) 3

4 Additional examination If we find hidden blood in your stool, you will be invited to have an examination (a colonoscopy) done. This examination will show whether the blood comes from a tumour or something else completely. Just because you have blood in your stool, it does not necessarily mean you have bowel cancer far from it. No test is 100 per cent sure It is important that you follow the directions for the screening test very carefully, or you may receive incorrect results. No test is 100 per cent certain, so there is always the risk of incorrect test results, even if you follow the instructions to the letter. Incorrect results can be either false positive or false negative results. A false positive result If the test result is a false positive, then we suspect there may be cancer, but then further testing will most likely show that you do not have this illness. Two out of a hundred persons taking the test will be told that blood was found in their stool even though they do not have cancer. A false positive may be the result of your eating meat that was not thoroughly cooked during the days when you took the test, or it may be due to a tear in the intestinal wall, or it could be piles or haemorrhoids. A false negative result A false negative result means the screening test shows there is no blood in the stool. This means there is no sign of cancer, even though you might still actually have the disease. Out of ten people with cancer, this screening test will find six of them. This means that four out of ten people who have bowel cancer will be told there is no sign of cancer. A tumour in the bowel does not always bleed, which means a person may have a tumour even though there is no blood in his/her stool. When stool samples are collected on three separate days, however, there is a better chance of finding blood in the stool, if there is any. If, however, you ate or drank too much vitamin C during the test period, a false negative may be the result. Advantages and disadvantages If you take the screening test, bowel cancer may be detected at an early stage. This improves chances of a complete recovery, which means fewer people will die of bowel cancer. There may also be disadvantages to taking the screening test. A false positive result means the patient will be worried for no reason and will need to have a special examination (colonoscopy) before doctors can say for sure that he/she does not have bowel cancer. On the other hand, people who receive false negative test results will believe that they do not have cancer. The test will not have shown signs of bowel cancer, even if they have the disease. Countywide screening for bowel cancer (Engelsk) 4

5 Further information If you have any questions about the screening process, you are welcome to telephone Kræftlinien (the Cancer Hotline) on Manning the telephones are doctors and nurses who speak both Danish and English, and they can answer any questions you may have about the test, colonoscopy or bowel cancer in general. The hotline is open Tuesdays and Thursdays between 9 am and 9 pm. If you have questions about the test result you receive by post, or if you would like a new test kit, please ring the Screening Unit on Read more about the countywide screening campaign and bowel cancer at or To receive the Danish brochure Kræft i tyktarmen og endetarmen (Cancer of the colon and rectum), please ring Countywide screening for bowel cancer (Engelsk) 5

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