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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. 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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