Rachael Ferguson had the next stage of her life planned out. The 33-year-old got married in November 2020 and planned to start trying for a baby with her husband.
She'd had an "unsettled and stressful" year and thought: "We've got through the worst of everything."
But that December, Ferguson received news that made her wonder if she should start planning her funeral.
She had been diagnosed with Stage 4 bowel cancer - she was left "shocked" and "numb" after discovering she had what she thought was "an old person's disease" at 32.
The next day: "I went home and I just cried and I cried like I've never cried before".
She recalls looking at herself in the mirror telling herself everything was going to be okay.
"Whether I knew that or not, I had to believe that."
Nearly 18 months later, after undergoing surgery and chemotherapy, Ferguson is pregnant and says life is "pretty much" back to normal.
In light of her experience, Ferguson believes the age for the National Bowel Screening Programme in New Zealand needs to be lowered to 35. It is currently for those aged between 60 and 74.
Bowel cancer is the second-highest cause of cancer death in New Zealand. More than 3000 people are diagnosed with bowel cancer and more than 1200 people die from it each year. But if found early, it can often be treated successfully, the Bay of Plenty District Health Board said.
Ferguson said: "I just know so many people in their 30s being diagnosed."
"This can affect absolutely anybody at any age at any time. There should be no age bracket."
Her views are supported by Tauranga man Brett Morrison, who lost his 32-year-old wife Sarah to bowel cancer in May 2015, and by 45-year-old Tauranga woman Tania Hilliam who has now been "cancer-free" for more than two years after being diagnosed with Stage 4 bowel cancer in 2019.
Ferguson only discovered something was wrong after seeing her doctor about her hereditary blood condition. Blood tests showed she was "severely anaemic" and she remembered seeing a few bits of blood in her stool.
"I'd only noticed it a handful of times ... and because of that, I was then referred for a procedure.
Ferguson was alone at Tauranga Hospital when she was diagnosed, as she thought she just had haemorrhoids.
Instead, "I was pretty much told with a camera up my bum that I had cancer.
"You sort of think, am I going to die?"
After her diagnosis, she had surgery and six months of chemotherapy.
She now wants to raise awareness about the symptoms of bowel cancer, particularly among young people, and to remove the stigma that bowel cancer was "an old person's disease".
"There is not enough awareness around for young people or for any person in general - there needs to be more.
"We're seeing a complete change of direction where it's actually younger people [getting diagnosed with bowel cancer]. It's on the rise for them and it's quite scary."
Before her diagnosis, she knew nothing about bowel cancer and it did not run in the family.
She said the "key" symptom to look for was bleeding from the bottom or blood in the stool.
Other symptoms included having a sore stomach, feeling bloated, a change in bowel habits and unexplained weight loss and tiredness, she said.
Ferguson started an online petition about lowering the screening age to 35 to give others the chance of an early diagnosis.
"If we can lower the bowel screening age, that in itself will raise awareness for younger people to look at it and go, okay this can affect me and I do need to get checked."
Tauranga woman Tania Hilliam, 45, was diagnosed with Stage 4 bowel cancer in 2019 when she was 42. While Hilliam has been "cancer-free" for nearly two-and-a-half years, she is "not out of the woods" yet.
Hilliam believes the screening age should be lowered to 35 or 36.
People in their 40s were being diagnosed when it was already "advanced," she said.
She said the age should be lowered because people were not recognising they had symptoms, such as an upset stomach or bowel habits changing, and would "write it off" as something else.
"It's going to be less taxing on the health system in the long run, and we've got heaps of young Kiwis going through this and it's really hard on their families.
"Alarm bells definitely need ringing."
Tauranga man Brett Morrison lost his wife Sarah Morrison to bowel cancer in May 2015. Sarah died when she was 32 - 10 months after being diagnosed with Stage 4 bowel cancer.
Morrison said bowel cancer was treatable if caught early.
"But the problem in New Zealand is we don't catch it early.
"I think if we had a bigger screening for it, the country would save money ... we'll save lives."
Bowel Cancer New Zealand nurse support coordinator Victoria Thompson said it wanted the age criteria for regular screening to include those aged 50 and older.
"Anecdotally, we are hearing more stories of younger New Zealanders being diagnosed with bowel cancer. They are often misdiagnosed with irritable bowel disease and told they are 'too young' for bowel cancer."
"Bowel cancer is not just a disease of our older population."
Ministry of Health clinical director of the National Bowel Screening Programme Dr Susan Parry said whilst cases of bowel cancer were increasing for people in their 30s, it was still "rare" in this age group.
"It is very important for people of any age to be aware of their bowel health and to report any symptoms, such as a change in their toilet habit that lasts several weeks or the appearance of blood in a bowel motion, to see their doctor without delay."
Parry said the age range for the programme's eligibility was based on data from the pilot programme which ran in the Waitemata District Health Board from 2011 to 2017. It showed 80 per cent of bowel cancer occurred in people over 60.
The age range was introduced to establish a "clinically safe and effective bowel screening programme within existing resources" before reviewing the age range at "some later date".
Parry said no national bowel screening programme in the world had a starting age younger than 50.
The Bay of Plenty District Health Board said the National Bowel Screening Programme was rolling out in the Bay from this month, aiming to save lives through the early detection of bowel cancer. More than 50,000 men and women between 60 and 74 were eligible for the free programme in the Bay.
Last week, Ferguson was reminded by an Instagram memory it had been one year since she had her first chemotherapy treatment.
"I just thought far out, here I am 21 weeks pregnant and then this time last year I was sitting down being dosed up with chemotherapy drugs."
She and the baby were both "perfectly healthy".
Bowel cancer symptoms:
- A change in bowel habits over a period of time without returning to normal i.e. more or less frequent, incomplete emptying, texture changes.
- Unexplained pain in the abdomen - this may be intermittent and severe.
- Lumps in the abdomen
- Bleeding of any kind from the bottom or noticed when wiping.
Source: Bowel Cancer New Zealand