Download the options for improving the success of the national bowel cancer

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I: www.gutfoundation.com.au
President:
Prof TD Bolin
THE OPTIONS FOR IMPROVING THE SUCCESS OF
THE NATIONAL BOWEL CANCER SCREENING PROGRAMME.
Bowel Cancer is the commonest internal malignancy in Australia, which has one of the highest
rates of bowel cancer in the world.
There are an estimated 14,234 new cases of bowel cancer and from that 4,047 deaths. This
results in 40 new cases diagnosed every day of whom 11 will die because the diagnosis is made
too late.
The current National Bowel Cancer Screening Program begins at the age of 50 and continues at 5
yearly intervals thereafter. This program has shown that 11.2% of patients aged 40 to 49 with a
positive test (patients over 70 excluded) alerts us to the need for screening at an earlier age with
the prospect of prevention.
Cancer and large polyps bleed though not obviously and the bleeding can be detected by an
immunochemical test.
The cancers and polyps do not bleed all the time and testing should therefore be done annually.
Polyps grow slowly over 5 - 15 years.
The screening options for bowel cancer prevention and diagnosis are faecal occult blood testing
or colonoscopy.
The acceptance rate by patients in the NBCSP declines each year (currently 35%). To improve this
rate of acceptance, having screening done through general practitioners has attractions because
they already manage other screening programmes.
We therefore carried out a screening program in Wagga during 2013 through general practice
with no age exclusions.
ABN 14 084 315 380 (Incorporated in NSW)
In Wagga the rates of positive tests was 14.4% and the age group 40-49 accounted for 25% of all
positive tests.
Of the 51 patients aged 40-49 in Wagga, 2 had early cancers, 4 large polyps and 4 multiple polyps
– all likely to become cancer.
Their removal is therefore the key to PREVENTION.
We have carried out a cost effectiveness study between the ages of 40 to 70 and comparing
annual, biennual FOBT with colonoscopy at the age of 40, 50 and then 5 yearly thereafter. The
results indicate that annual FOBT is the most cost effective (costing 149.8 million dollars) with a
net benefit of 2.6 billion dollars.
This was largely accounted for by trebling of better survival with annual FOBT for (40.9 versus
139.5), fewer deaths with screening (102 versus 309) and a cost effectiveness ratio ($15,719
versus $27,620)
See attached table
We believe that incorporating colorectal cancer screening through general practice together with
screening for breast cancer, diabetes, prostate cancer, hypertension and hyperlipidaemia is a
sensible approach.
We can predict that there is an increased risk of bowel cancer in only 1 in 5 cancers, this increase
being due to family history of polyps or cancer.
The other 4 out of 5 have no obvious risk factor with lifestyle factors which include physical
inactivity, cigarette smoking, obesity, low fibre intake and low vegetable and fruit intake together
with alcohol have significant impact.
There is therefore a case to be made for improving dietary advice through general practice which
will benefit not only colorectal cancer but also cardiovascular issues.
We plan to begin a further study in Port Macquarie under the auspices of the New South Wales
Rural Clinical Health School and local general practice to evaluate the success of such an
approach.
Reducing the screening age to 40 years, has the potential to save 600 lives per year.
Professor Terry Bolin
The Gut Foundation
March 2014
ABN 14 084 315 380 (Incorporated in NSW)