10 July 2017

Why the bowel-screen program is falling short

Cancer Government Public Health

Tens of thousands of preventable deaths could occur in the next two decades if GPs continue to be overlooked in the implementation of the National Bowel Cancer Screening Program, medical experts warn.

New modelling led by researchers at Cancer Council NSW shows that while the current uptake of 40% will have a major impact on bowel cancer rates, another 25,000 lives could be saved between now and 2040 if uptake rates could be increased to 60%.

At the moment, uptake in Australia is lower than other colorectal screening programs and internationally accepted targets.

According to AMA vice president Dr Tony Bartone, a major reason for the poor uptake rates has been that the program was introduced without much collaboration with general practitioners.

“When we understand the target group, over-50s, they have a very strong relationship with their GPs,” he said. “And it would have made more sense to bring GPs into the equation up front.”

“Whenever [GPs] send a patient off for a referral for an FOBT there’s a high rate of compliance because there is a messaging factor and there is obviously a symptom that’s presented,” he said.

But the current program does not alert GPs when someone is sent a test, only when it is completed, and even this is fractured further because this is sometimes sent as snail mail and other times sent as a secure smart form, Dr Bartone said.

This year, Australians aged 50, 54, 55, 58, 60, 64, 68, 70, 72 and 74 years will be sent the free immunochemical bowel cancer screening kit in the mail, but by 2019 the program will increase the testing to every two years.

Dr Bartone said that the additional money for testing needed to be accompanied by significant public-health messaging, collaboration with general practice and better infrastructure to track patients.

While it might not be possible to alert a GP the first time somebody was invited to undergo the test, Dr Bartone said that once the person was in the system and had nominated a GP, it would be useful to send the practitioner a notification each time the test was sent.

In addition, the government could work with practice management software companies to develop regular reminders to leverage the important role GPs played in preventive health, he said.

“It needs a multipronged approach,” he said. “If you just focus on one side of the equation and hope that other people come on board, you don’t get the bang for your buck – and this is too big an issue not to be taken more seriously.”

Colorectal cancer is the third most common cancer in Australia, and the second highest cancer killer, after lung cancer.

A study, which was published in Lancet Public Health, validated the introduction of the scheme, and estimated it would prevent 92,000 cancer diagnoses and 59,000 deaths between 2015 and 2040.

This would save $1.7 billion in health expenditure over the period, or $2.1 billion if participation rates could be increased to 60%.

“Despite its preventive effect, the model predicts that screening at the current participation level will not bring the number of colorectal cancer diagnoses and deaths per annum below current numbers,” Dutch experts wrote in an accompanying editorial.

However, gastroenterologist Dr Cameron Bell said the current uptake figure of 40% was likely to be an underrepresentation of the true number of individuals being screened for bowel cancer.

The reality was a substantial number of people in the community were having FOBTs or colonoscopies as surveillance  of previous polyps or screening due to strong family history, and understandably throwing their FOBT kits away when they received it, said Dr Bell, a spokesperson for the Gastroenterological Society of Australia.

He was positive about the uptake and efficacy of  the program so far. He suggested that some people might be being screened with regular colonoscopies unnecessarily, either because they had a weak family history, or because there was a misconception that FOBT was inferior to colonoscopy.

“Of people who have been screened recently with an FOBT as part of the program, the chance of having bowel cancer in the next two years is one in 1000,” Dr Bell said.

To ensure the program reached its full potential, patients needed to be reassured that the FOBT was a powerful and effective screening tool, he said.

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4 Comments on "Why the bowel-screen program is falling short"

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Fabian Jaramillo
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Fabian Jaramillo
3 months 21 days ago

I think GPs have a responsibility with their patients and the health system from which they derive their income, to engage in health promotion and disease prevention strategies regardless of whether or not additional incentives are provided.

Engaging with their patients and ensuring their participation in national health programs like the Bowel, Cervical and Breast cancer screening programs should be business as usual for all GPs providing “primary care”.

GPs in Australia need to realize the importance of becoming more proactive with respect to preventive medicine and where possible, move away from the reactive care that is threatening our health system.

David Chan
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David Chan
4 months 7 days ago
Sir – as a GP trying to give latest, best and most efficacious advice on screening for bowel cancer, I still have great problems with recommending FOBT or colonoscopy. As mentioned, colorectal cancer is the 3rd most common cancer in Australia and mortality rates , 2nd highest after lung cancer. With Cancer being the major cause of overall mortality, overtaking CVS disease in Australia, cancer screening for all cancers especially bowel and prostate is a very significant issue for GPs. My research into FOBT shows that FOBT is indeed a powerful and effective screening tool , however the quoted reduction… Read more »
Neil Donovan
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Neil Donovan
4 months 8 days ago
I may be a lone voice but if a patients mentions the programme to me , I immediately offer my own FOB collection kit and form. Why would I trust it to a tainted government initiative? Why would I trust it to a letter?. I have my own recall systems . I have my own screening tools. I want to order the tests and follow up and have it my records. So I wonder these figure simply mean that GP’s are managing their own screening and I guess there is no way to sort that data. (I assume, no one… Read more »
Andrew Miller
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Andrew Miller
4 months 9 days ago

https://m.youtube.com/watch?v=-SF9tOXQSaY

Other groups were involved at the grassroots. GPs & service groups should be enlisted.

How did we achieve just 6 cases of Polio for the first half of 2017? Concerted coordinated long-term community action!

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