Hello, I’m Professor Finlay Macrae, Gastroenterologist and Head of Colorectal Medicine and Genetics at the Royal Melbourne Hospital. I joined the editorial board of the Virtual Gastro Centre a few months ago and today I would like to share with you my insights on screening for bowel cancer through the National Bowel Cancer Screening Program.
Bowel Cancer is the commonest internal cancer in Australia and the second commonest cause of cancer death. Nearly 13,000 Australian are diagnosed each year with nearly 5,000 deaths annually.
If diagnosed at a stage before it is spread beyond the bowel wall the chances of survival after surgical resection are high. If diagnosed when spread beyond this, survival drops sharply. Although chemotherapy offers a 10-20% improvement in survival in the more advanced stages of the disease.
Testing the stool or faeces for hidden quantities of blood before obvious bleeding or other symptoms are noted, called Faecal Occult Blood Testing, can lead to the detection of cancer which in these circumstances is nearly always early and curable by surgery or endoscopic treatment. In addition, many pre-malignant adenomatous polyps will be detected in the follow-up colonoscopy, some of which will turn into cancer if not removed.
Thus screening for bowel cancer through an organised program of Faecal Occult Blood Testing will lead to a reduction in deaths and even the initial appearance of bowel cancer.
In highly respected international trials of Faecal Occult Blood Testing the death rate for bowel cancer was reduced by 17-33% in those offered testing compared to controls who did not receive the offer for screening. And by 40% in those who were offered and who actually did the test. Accumulating the results of over 5 such trials has led to the most solid evidence that this approach will reduce the death rate from bowel cancer.
On this basis, the Australian government has introduced the National Bowel Cancer Screening Program following a successful pilot program conducted in Victoria and South Australia and rural Queensland from 2002 to 2004. All Australians turning 55 or 65 years of age are being offered a Faecal Occult Blood Test at present. With continuing political support for funding it is envisioned that all Australians between 55 and 75 will receive a testing kit every second year by the year 2015.
Colonoscopy is needed to evaluate those with a positive test. Colonoscopy is a tube test done by a doctor which allows the whole of the large bowel to be visualised. A bowel preparation is required before the procedure to clean the bowel out and sedation is administered to make it comfortable. Although there are some risks attached to the procedure the benefits far outweigh the risks. Especially in those with a positive Faecal Occult Blood Test. About 5% of people with a positive test will have cancer and another 12% with large but still benign adenomatous polyps.
The program does not specify the access to colonoscopy that suggest that GPs or other nominated healthcare providers arrange colonoscopy through usual care mechanisms. This has placed some stress on state health providers but most states have now developed programs to cope with the load and reporting requirements of the National Bowel Cancer Screening Program. For example, in Victoria and Queensland a preferred provider system is being implemented, linked with state funding specifically for the pilot program screenees, and caring responsibilities to maintain quality in services and reporting to the National Bowel Cancer Screening Program register centrally. It’s imperative that reporting of outcome from colonoscopy is accurate and complete so that the value of the program can be assessed and any refinements in the approach tailored.
The National Bowel Cancer Screening Program is an exciting, soundly based, Australian government initiative, which is one of only two in the world which is population based and centrally administered. Many Australian lives will be saved. All stakeholders in the program, from patients to providers and governments, need to respect and respond to the program if we are to see its benefits.
Thank you for watching and have a great day.
|For more information on bowel cancer, types of bowel cancer, and its tests, treatments and useful videos, see Bowel Cancer (Colorectal Cancer).|
|For more information on colonoscopy procedures and how to prepare for one, see Colonoscopy.|
|For more information on the National Bowel Cancer Screen Program, see Screening for Bowel Cancer (Colorectal Cancer).|
|For more information on Bowel Cancer Australia and how this organisation works to reduce the impact of bowel cancer in our society, see Bowel Cancer Australia.|
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