English: Well, my only own experience is that one of my grandmothers died before I had a chance to know her, because she was taken by bowel cancer when I was two months old. Bowel cancer is the fourth most common cancer in the UK. Around 16,000 people die from the disease each year - 900 in Wales - making it the second biggest cancer killer. The scale is growing, where it is estimated that between now and 2035, around 332,000 additional lives could be lost to the disease across the UK, and this shouldn't be the case, because the disease is preventable, treatable and even curable. Nine in ten people will survive bowel cancer if diagnosed at the earliest stage. Screening is the most effective method of detecting bowel cancer early and plays a key role in improving survival rates. Across the UK, bowel cancer screening programmes send everyone aged between 60 and 74 a home testing kit - and I note David Melding's comments earlier, in that context - every two years. In Scotland, they are also sent to people in their 50s. Referral by GP is still the route by which most people are diagnosed. Referral through primary care is a key route to diagnosis for those who experience symptoms that could be bowel cancer, and for those below the age covered by the screening programme. People who experience symptoms should be referred for the most reliable and accurate diagnostic tests for bowel cancer available: a colonoscopy and flexible sigmoidoscopy, which can detect cancer at the earliest stage of the disease. While effective public health awareness programmes can alert people to the symptoms of bowel cancer and encourage them to seek advice from their GP, it's also important that GPs are able to recognise these symptoms and refer appropriately and promptly. However, as the symptoms of bowel cancer can be hard to diagnose accurately, and can also be symptoms of other less serious and more common bowel conditions, it can be difficult for GPs to know who to refer and when. This can result in delays to patients being able to access diagnostic services and, in some cases, patients having to see their GP more than five times before referral. NICE guidelines for suspected cancer, updated in July 2017, are in place to help GPs to make these decisions. These recommend that the faecal immunochemical test, or FIT, is adopted in primary care to guide referral for suspected bowel cancer in people without rectal bleeding, who have unexplained symptoms but do not meet the criteria for a suspected cancer referral pathway. Using FIT in this way could help GPs to better identify and refer the right patients quickly and detect bowel cancer early. We need to see this adopted in Wales before 2019, alongside England and Scotland, where it has already been piloted and used in some areas. The annual cancer report recognises that a poor interface between primary and secondary care is a major cause of delays for cancer patients. In response to this, the Welsh Government included recognition and early referral of cancer as part of the Wales GP contract for 2017-18. This requires primary care teams to develop strategies to improve recognition and early diagnosis. These interventions should support earlier diagnosis of people with cancer who present in primary care, and may also potentially lead to a reduction in demand for colonoscopy services. Jackie Hill from Wrexham was diagnosed with bowel cancer after repeated trips to see her GP. She said: 'my GP examined me but could not detect a lump. I was given laxative and told to go back in the New Year. I went back and told my GP that I was bleeding even more and felt very tired. My blood test came back normal. I went back again three months later as the bleeding was very heavy, but I was told there was nothing wrong. Eight months after my first visit, I returned and was referred for the camera to allay my fears, but never once was cancer considered as the blood tests had come back normal and I was told I was too young for cancer. At one time my GP even said to me: "And what do you want on this urgent appointment?" I was finally diagnosed with stage 2 cancer. I thought, very naively, when I was diagnosed that I would have the tumour removed and then back to normal. Because of the consequences of my treatment, I am constantly worried about going out of the house and many times when I am ready to leave the house I have to go to the toilet. My first thought when I go anywhere is where the toilets are and will they be clean.' Wales must therefore optimise bowel cancer screening by using FIT at the optimal sensitivity threshold, expanding the age range and increasing uptake. Thank you.
Welsh: Wel, yr unig brofiad sydd gennyf fi yw bod un o fy neiniau wedi marw cyn i mi gael cyfle i'w hadnabod, gan iddi gael ei chymryd gan ganser y coluddyn pan oeddwn yn ddau fis oed. Canser y coluddyn yw'r pedwerydd canser mwyaf cyffredin yn y DU. Mae oddeutu 16,000 o bobl yn marw o'r clefyd bob blwyddyn - 900 yng Nghymru - gan ei wneud yn ail ganser mwyaf sy'n lladd. Mae'r gyfradd yn tyfu, ac amcangyfrifir rhwng nawr a 2035 y gallai tua 332,000 o fywydau ychwanegol gael eu colli i'r clefyd ledled y DU, ac ni ddylai hyn fod yn wir, gan ei fod yn glefyd y gellir ei atal, ei drin a hyd yn oed ei wella. Bydd naw o bob deg o bobl yn goroesi canser y coluddyn os ceir diagnosis ar y cam cynharaf. Sgrinio yw'r dull mwyaf effeithiol o ganfod canser y coluddyn yn gynnar ac mae'n chwarae rôl allweddol yn gwella cyfraddau goroesi. Ledled y DU, mae rhaglenni sgrinio canser y coluddyn yn anfon pecyn prawf cartref i bawb rhwng 60 a 74 oed - a nodaf sylwadau David Melding yn gynharach, yn y cyd-destun hwnnw - bob dwy flynedd. Yn yr Alban, cânt eu hanfon hefyd at bobl yn eu 50au. Atgyfeiriad gan feddyg teulu yw'r llwybr y caiff y rhan fwyaf o bobl ddiagnosis o hyd. Mae atgyfeirio drwy ofal sylfaenol yn llwybr allweddol i ddiagnosis ar gyfer y rhai sy'n profi symptomau a allai fod yn ganser y coluddyn, ac ar gyfer rhai o dan yr oed a gwmpesir gan y rhaglen sgrinio. Dylid cyfeirio pobl sy'n profi symptomau am y profion diagnostig mwyaf dibynadwy a manwl sydd ar gael ar gyfer canser y coluddyn: colonosgopi a sigmoidosgopi hyblyg, sy'n gallu canfod canser ar gam cynharaf y clefyd. Er y gall rhaglenni ymwybyddiaeth iechyd cyhoeddus effeithiol hysbysu pobl am symptomau canser y coluddyn a'u hannog i ofyn am gyngor gan eu meddyg teulu, mae hefyd yn bwysig fod meddygon teulu yn gallu adnabod y symptomau hyn a chyfeirio'n briodol a phrydlon. Fodd bynnag, gan fod symptomau canser y coluddyn yn gallu bod yn anodd gwneud diagnosis cywir ohonynt, a hefyd yn gallu bod yn symptomau cyflyrau'r coluddyn eraill llai difrifol a mwy cyffredin, gall fod yn anodd i feddygon teulu wybod pwy i'w hatgyfeirio a phryd. Gall hyn arwain at oedi cyn y gall cleifion gael gwasanaethau diagnostig ac mewn rhai achosion, rhaid i gleifion weld eu meddyg teulu fwy na phum gwaith cyn cael eu hatgyfeirio. Mae canllawiau NICE ar gyfer achosion lle y ceir amheuaeth o ganser, a ddiweddarwyd ym mis Gorffennaf 2017, ar gael i helpu meddygon teulu i wneud y penderfyniadau hyn. Maent yn argymell y dylid mabwysiadu'r prawf imiwnocemegol ysgarthion, neu FIT, mewn gofal sylfaenol i arwain atgyfeiriadau lle yr amheuir canser y coluddyn mewn pobl heb waedu rhefrol, sydd â symptomau heb eu hesbonio ond nad ydynt yn bodloni'r meini prawf ar gyfer llwybr atgyfeirio oherwydd amheuaeth o ganser. Gallai defnyddio FIT yn y modd hwn helpu meddygon teulu i nodi ac atgyfeirio'r cleifion cywir yn well ac yn gyflym a chanfod canser y coluddyn yn gynnar. Mae angen inni weld hyn yn cael ei fabwysiadu yng Nghymru cyn 2019, ochr yn ochr â Lloegr a'r Alban, lle mae eisoes wedi'i dreialu ac yn cael ei ddefnyddio mewn rhai ardaloedd. Mae'r adroddiad blynyddol ar ganser yn cydnabod mai'r berthynas wael rhwng gofal sylfaenol ac eilaidd sy'n achosi llawer o'r oedi i gleifion canser. Mewn ymateb i hyn, cynhwysodd Llywodraeth Cymru ganfod ac atgyfeirio canser yn gynnar yn rhan o gontract meddygon teulu Cymru ar gyfer 2017-18. Mae'n ei gwneud yn ofynnol i dimau gofal sylfaenol ddatblygu strategaethau i wella canfod a diagnosis cynnar. Dylai'r ymyriadau hyn gefnogi diagnosis cynharach i bobl â chanser mewn gofal sylfaenol, a gallent hefyd arwain at ostyngiad yn y galw am wasanaethau colonosgopi. Cafodd Jackie Hill o Wrecsam ddiagnosis o ganser y coluddyn ar ôl sawl ymweliad â'i meddyg teulu. Dywedodd: 'cefais archwiliad gan fy meddyg teulu, ond ni lwyddodd i ganfod lwmp. Rhoddodd garthydd i mi a dweud wrthyf am ddychwelyd yn y flwyddyn newydd. Dychwelais a dywedais wrth fy meddyg teulu fy mod yn gwaedu rhagor hyd yn oed ac yn teimlo'n flinedig iawn. Daeth fy mhrawf gwaed yn ôl yn normal. Dychwelais eto dri mis yn ddiweddarach gan fod y gwaedu'n drwm iawn, ond dywedwyd wrthyf nad oedd unrhyw beth o'i le. Wyth mis ar ôl fy ymweliad cyntaf, dychwelais a chefais fy atgyfeirio i gael y camera er mwyn tawelu fy ofnau, ond ni chafodd canser ei ystyried unwaith gan fod y profion gwaed wedi dod yn ôl yn normal a dywedwyd wrthyf fy mod i'n rhy ifanc i gael canser. Ar un adeg, dywedodd fy meddyg teulu wrthyf: "A beth ydych chi ei eisiau yn yr apwyntiad brys hwn?" Cefais ddiagnosis o ganser cam 2 yn y pen draw. Yn naïf iawn, pan gefais y diagnosis, credwn y buaswn yn cael tynnu'r tiwmor ac yna'n dychwelyd i fywyd normal. Oherwydd canlyniadau fy nhriniaeth, rwy'n gyson yn pryderu am fynd allan o'r tŷ a sawl gwaith pan fyddaf yn barod i adael y tŷ rhaid i mi fynd i'r toiled. Y peth cyntaf sy'n mynd drwy fy meddwl pan af i unman yw ble mae'r toiledau ac a fyddant yn lân.' Felly rhaid i Gymru wneud y defnydd gorau o sgrinio canser y coluddyn drwy ddefnyddio FIT ar y trothwy sensitifrwydd gorau, ehangu'r ystod oedran a chynyddu'r nifer sy'n cael eu sgrinio ar gyfer canser y coluddyn. Diolch.