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Bowel cancer screening rates down


Anastasia Tsirtsakis


16/06/2023 1:27:32 PM

Though participation in screening has dropped, wait times for colonoscopy referrals are in excess of the recommended 30-day timeframe.

A patient holding a NPCSP kit.
Increasing the screening rate to 60% could save 84,000 lives by 2040.

Bowel cancer is Australia’s second deadliest cancer, claiming more than 100 lives per week.
 
And while 90% of cases could be successfully treated, if detected early, participation in the National Bowel Cancer Screening Program (NBCSP) has dropped.
 
According to the latest NBCSP Report, released on Friday, just 2.49 million of the 6.1 million Australians aged 50–74 invited to participate in the screening program in 2020–21 (40.9%) took part.
 
That is down from 43.8% in 2019–20, with 179,000 fewer people taking part, returning the participation rate to what it was in 2015–16, while increased colonoscopy wait times for those who return a positive result are compounding the issue.
 
The NBCSP performance framework recommends that those who receive a positive screening result – meaning blood is detected in the sample – undergo a colonoscopy within a maximum of 30 days.
 
However, according to the report, for the 76,880 participants who received a positive result, the average national wait for a colonoscopy was 147 days – far in excess of the recommended 30 days.
 
Wait times have increased in every state and territory, varying from 119 days for people in Western Australia up to 235 days in Tasmania. That is an increase from 113–190 days in 2019–20.
 
Only 11,990 of the 76,880 participants who required further investigation were able to have a colonoscopy within the recommended 30-day timeframe.
 
Bowel Cancer Australia CEO, Julien Wiggins, said if a positive result is not promptly followed by a colonoscopy that ‘the opportunity for early detection is lost’.
 
‘We need to ensure participants are not left waiting for long periods after receiving a positive screening result, not knowing if cancer is present,’ he said.
 
‘As so few participants are receiving colonoscopies within the clinically recommended time frame, questions need to be asked.’
 
Guidelines acknowledge that wait times exceeding 120 days between the first healthcare presentation – for symptoms or a positive screening result – and a colonoscopy are associated with poorer clinical outcomes. Prompt follow up is also important to minimise the risk of psychological harm.
 
According to preliminary data from Cancer Council Victoria’s Centre for Behavioural Research in Cancer (CBRC), the drop in participation rates has been partly attributed to the 2019–20 bushfires, with participation rates in affected areas during that period down by 27%. Similarly, in flood affected areas, a 23% drop in participation was observed.
 
The NBCSP participation rate in 2020–21 was highest in South Australia and Tasmania (44.4%) and lowest in the Northern Territory (25.6%). Those living in inner regional areas were more likely to take part (43%) than those in very remote areas (25%).
 
If the national screening rate is increased from 40.9% to 60%, there is evidence to suggest that 84,000 lives could be saved by 2040.
 
With June marking Bowel Cancer Awareness Month, the Federal Government announced on Friday a $10.8 million investment in a bid to increase screening numbers.
 
For the second year in a row, the Government has partnered with Cancer Council Australia for a national bowel screening campaign to remind Australians to ‘Get2It’. Rolled out in April, it will ramp up this month until November.
 
‘We know cancer screening saves lives – and not screening costs us lives,’ Federal Health and Aged Care Minister, Mark Butler, said.
 
‘I’ve done the bowel screening test myself, and I encourage every Australian who receives the free test in the mail to also Get2It.’
 
In addition to national campaigns, when it comes to promoting participation in bowel cancer screening, Professor Jon Emery from the University of Melbourne previously told newsGP that GPs are ideally placed to assist.
 
‘GPs are key to discussions around cancer screening, to promoting both informed choices in … screening and increased participation, particularly in the NBCSP,’ he said.
 
‘One of the most effective strategies [for reducing bowel cancer deaths] is really to try and increase participation.
 
‘General practice plays a key role in promoting the program and checking that patients are up to date with their bowel cancer screening.’
 
The Government has advised that healthcare providers, including GPs, can now bulk order NPCSP kits and issue them to eligible patients – a move the RACGP has long called for.
 
In Australia, more than 15,600 people are diagnosed with bowel cancer each year. There has also been an uptick in cases among younger people, with one-in-10 new cases now occurring in those aged 50 and under who are currently ineligible to participate in the screening program.
 
More information on bowel cancer screening for health professionals is available on the Cancer Council Australia website. GPs can also access Get2It campaign materials for their patients in Arabic, Cantonese, Mandarin, Greek and Italian.
 
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bowel cancer Bowel Cancer Australia Bowel Cancer Awareness Month campaign Cancer Council Australia cancer screening colonoscopy early detection Get2It


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Dr Danene Hopkins   16/06/2023 5:09:30 PM

I'm all for screening and promote it regularly but just thinking that these figures would not take into account those individuals already on 3-5 yrly screening colonoscopies based on previous polyps detected etc?