Download Consultation flipchart for use with patients - PDF

INFORMATION LINE - 1800 118 868
www.cancerscreening.gov.au
Consultation Flipchart
For use with patients
Key Messages
Faecal Occult Blood Test (FOBT) Results
•
In Australia the lifetime chance of developing bowel cancer before the age of 75 years is
around 1 in 19 for men and 1 in 28 for women1. This is one of the highest rates of bowel
cancer in the world.
•
In Australia, there are over 14,000 new cases and
approximately 4,000 deaths from bowel cancer each year2.
A positive FOBT result does not necessarily mean you have cancer. FOBTs do not detect cancer.
A FOBT can detect small amounts of blood in the faeces or bowel motion, which may be a sign
that there is a cancer or pre-cancerous growth present. A positive FOBT usually means a 5%
chance of cancer, which is why follow-up investigation is essential.
•
If cancer is detected before it has spread beyond the
bowel, the chance of surviving at least five years
after diagnosis is 90%3.
•
The risk of developing bowel cancer rises sharply
and progressively from the age of 50.
•
Regular screening using a Faecal Occult Blood Test
(FOBT) can significantly reduce the number of
Australians who die each year from bowel cancer.
•
People can also lower their risk of bowel
cancer by eating a healthy diet and
exercising regularly.
The presence of blood may be due to conditions other than cancer, such as polyps, haemorrhoids,
or inflammation of the bowel, but the cause of the bleeding needs to be investigated.
The beginnings of bowel cancer
Illustration adapted from the original illustration, courtesy the Cancer Council Victoria.
Colon
Australian Institute of Health and Welfare
(AIHW) 2012. ACIM (Australian Cancer
Incidence and Mortality Books).
AIHW: Canberra
1
2
Small Bowel
Ibid.
Commonwealth Department of Health and
Family Services, Colorectal Cancer Screening:
A report of the Australian Health Technology
Advisory Committee, Canberra, 1997, p 11.
3
Further Information
Rectum
Anus
Your state or territory cancer council provides a confidential service where you can talk about
your concerns or questions about cancer with specially trained staff. The staff can send you
written information and can put you in touch with services in your local area.
The Cancer Council Helpline: 13 11 20
Translating and Interpreting Service: 13 14 50
STORING YOUR SAMPLES
Store the blue Mailing Envelope
containing your samples between
2O and 10OC - the fridge is the
best place for your samples.
Product name
How to Collect
Your Samples
for Testing
>>>
Need help?
Call 1300 738 365
Monday - Friday (AEST)
between 9am to 5pm
Reading English
a difficulty?
Call us on 13 14 50
National Bowel Cancer
Screening Program Kit
Pathology Services
Mail the ‘Blue Mailing Envelope’
containing your test samples to:
Reply Paid 83974
Dorevitch Pathology
FOBT Department
PO Box 5018
Heidelberg West MDC VIC 3081
Do
Do
Sponsor of
NEW HEMTUBE (B)
Manufacturer of
NEW HEMTUBE (B)
FOBT002 Version 12/12
FOBT002.indd 1
not:
Change your diet or medication.
Freeze your samples.
not collect samples if:
You have haemorrhoids (piles)
which are bleeding.
It is during or within 3 days
either side of a menstrual
period.
Blood is present in your urine
or present in the toilet bowel
- in this case you should
contact your doctor.
You are scheduled for a
colonoscopy in the near future.
You have had a bowel condition
in the last 12 months which
is currently under treatment consult your doctor if you are
unsure.
Please read all pages before taking the 4
easy steps to collecting your two samples.
Quick, easy, done in
your own home when
convenient for you.
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FOBT002.indd 2
10/12/12 10:00 AM
INFORMATION LINE - 1800 118 868
www.cancerscreening.gov.au
Consultation Flipchart
For medical practitioner use
Bowel cancer is the most commonly occurring internal cancer reported,
and the second most common cause of cancer-related death, after lung
cancer. Around 80 Australians die of bowel cancer each week.
FOBT Results
Symptoms
Colonoscopy
Family History
All positive FOBT results require investigation
unless current illness prevents it.
Bowel cancer can develop with few, if any,
early warning symptoms.
In most cases colonoscopy will be the best method for
investigating positive FOBTs.
A positive FOBT may indicate:
The most common presenting
symptoms of bowel cancer are:
Possible complications of colonoscopy include:
More than 75% of people
who develop bowel cancer do
not have a family history of
bowel cancer.
• a polyp or adenoma;
• colorectal cancer;
• non-neoplastic lesion: haemorrhoids,
proctitis.
FOBTs are not 100% accurate and can
sometimes give a positive result when no
cause is identifiable.
During the Bowel Cancer Screening Pilot
Program the positive predictive value of the
Detect TM FOBT for suspected cancer was
5.1% and for suspected cancer or advanced
adenoma was 20.1%.
A negative result does not mean cancer is
not present as polyps and cancers can bleed
intermittently so blood may not be found.
This is why regular FOBT screening from the
age of 50 for people at general population
risk is so important.
The NHRMC Clinical Practice Guidelines
for the Prevention, Early Detection and
Management of Colorectal Cancer (2nd
edition, December 2005) recommend
screening with a FOBT, at least once every
2 years from the age of 50.
• bleeding from the rectum, either mixed
with or separate from the bowel motion;
• difficulties with bowel preparation;
• perforation of the colon (1 in 1000)*;
• symptoms of anaemia;
• major haemorrhage (3 in 1000)*;
• a recent and persistent change in bowel
habit;
• the procedure resulting in death (between 1 and 3
in 10,000)*;
• abdominal pain, especially if of
recent onset;
• possibility of laparotomy and/or blood transfusion
if bleeding or perforation occurs.
• unexplained weight loss
Overall, diagnostic colonoscopy is associated with a
complication rate of 0.14% compared to a rate of 2%
for therapeutic colonoscopy*. Approximately 5% of
colonoscopies are incomplete*, that is they do not
reach the caecum.
People with a family history of bowel cancer
are at increased risk and so there should be
a higher level of suspicion if they develop
bowel symptoms.
Bleeding often only becomes visible when
the cancer is more advanced.
Symptoms are not always clear-cut
and can have a variety of other causes
including more common conditions such
as haemorrhoids.
The NHMRC recommends that all symptoms
suggestive of bowel cancer be investigated,
especially in those people over 40 years of age.
Individuals are considered to
have a significant family history
of bowel cancer if a close
relative (parent, brother, sister or
child) developed bowel cancer
at a young age (under 50 years)
or if more than one relative on
the same side of their family
developed bowel cancer.
• complications of sedation and anaesthesia;
Individuals identified as
being at increased risk
should be managed as per
the NHMRC Guidelines.
Program statistics on recorded colonoscopy outcomes for
participants with a positive FOBT result4 show that around:
• 49% of people had a polyp/s or adenoma/s;
• 4% had a confirmed or suspected cancer found; and
• 47% had no cancer, polyp or adenoma. Blood
was associated with other conditions such as
haemorrhoids, diverticular disease, small lesions or
inflammation of the bowel.
If polyps, adenomas or cancer are found, treatment
and on going surveillance should reflect the
NHMRC guidelines.
* Data sourced from the NHMRC Clinical Practice
Guidelines for the Prevention, Early Detection and
Management of Colorectal Cancer (2nd edition,
December 2005), p 92.
Australian Institute of Health and Welfare
2012, National Bowel Cancer Screening Program
monitoring report Phase 2, July 2008 – June
2011. CANCER SERIES No. 65 CAN 61. Canberra:
AIHW, p105.
4