Varied bowel cancer screening rates across socioeconomic areas

Morgan Liotta

4/06/2019 1:26:44 PM

Participation rates are lower – but positivity rates higher – for those living in the lowest socioeconomic areas, a new report shows.

Bowel cancer test kit
Participation in bowel cancer screening varies according to geographical and socioeconomic status. (Image: Cancer Council)

The report, the latest from the Australian Institute of Health and Welfare (AIHW), monitored rates and results of participation in the National Bowel Cancer Screening Program (NBCSP) using key performance indicators.
Data was collated from the 41% of participants who underwent screening out of the 4.1 million people invited to participate in the NBCSP from January 2016 to December 2017.
For those participants screened in 2017, 8% had a positive result warranting further assessment, and one in 29 (3.4%) who underwent a follow-up diagnostic assessment were diagnosed with a confirmed or suspected cancer.
Monitoring participation in the NBCSP is based on access parity of relevant services for various population groups, including geographical location, socioeconomic area, Aboriginal and/or Torres Strait Islander status, language spoken at home and disability.
The AIHW report highlighted that routine monitoring of rates by various stratifications may reveal emerging trends for further investigation. For example, a higher proportion of Aboriginal and Torres Strait Islander participants live in the lowest socioeconomic areas and in very remote areas.
Australians living in the lowest socioeconomic areas had a lower participation rate in the NBCSP than those in higher socioeconomic areas. This group also experienced higher positivity rates, yet had a lower follow-up diagnostic assessment rate and a longer median time between a positive screen and an assessment.
Those in the lowest socioeconomic areas also had higher age-standardised bowel cancer incidence and mortality rates.
Further key findings show that in 2016–17:

  • participation rates in the highest socioeconomic areas were 42.9%, compared to 39% for those in the lowest socioeconomic areas
  • screening positivity rates were 9.3% in the lowest socioeconomic areas, compared to 6.7% in the highest
  • bowel cancer incidence rates per 100,000 was 112 for those in the highest socioeconomic areas, and 146 in the lowest
  • mortality rates per 100,000 was 25 for those in the highest socioeconomic areas, and 38 in the lowest.
The AIHW estimated that 8000 people aged 50–74 will be diagnosed with bowel cancer (approximately 49% of all bowel cancers diagnosed) in 2019, and 2000 people aged 50–74 will die from bowel cancer (approximately 35% of all bowel cancer deaths). It is also estimated that, after breast and prostate cancer, bowel cancer will be the third most commonly diagnosed cancer in Australians of all ages in 2019.
Non-modifiable risk factors for bowel cancer include age and family history, while modifiable risk factors include lifestyle, diet and screening.
June is Bowel Cancer Awareness Month and the NBCSP aims to reduce morbidity and mortality from bowel cancer by actively recruiting and screening the target population for early detection or prevention of the disease.
The RACGP also offers a suite of resources to assist general practice teams in providing preventive healthcare, including early detection and screening for bowel cancer:

bowel cancer National Bowel Cancer Screening Program screening

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Oliver Frank   5/06/2019 8:15:41 AM

It is important for GPs to know that they can request faecal occult blood testing essentially without restriction as a Medicare subsidised service in the same way as any other pathology test. Pathology practices supply FOBT kits free of charge to GPs.

A large part of the poor uptake of the National Bowel Cancer Screening Program arises from its failure to involve the person’s usual GP from the beginning of the process, and until recently to recognise that most general practices are computerised. Nigel Stocks and I pointed these factors out four years ago in a letter to the Medical Journal of Australia. (Oliver R Frank and Nigel P Stocks. A bowel cancer screening plan at last (letter). Med J Aust 2015; 202 (4): 180. doi: 10.5694/mja14.01547.)

I hope that the new National Cancer Screening Register will link more effectively and efficiently with people’s usual GPs or general practices, to help GPs to be able to remind their patients when screening is due.

Jan Sheringham   5/06/2019 9:51:02 AM

Agreed Oliver, but the initial invitation needs to be supported by a letter/reminder from the GP, sent within a week of the invite being mailed! Every practice should, as part of its prevention activities, send such a document every 2 years once every patient enters this screening range, associated with an in-record prompt to raise the value of the test at subsequent visits, ONLY disappearing once the result has been received and/or acted on. Such low participation rates , given the potential life savings, are totally unacceptable. Here is one ideal “KPI” for practice - initiated prevention.