Summary
Introduction
The National Bowel Cancer Screening Program (NBCSP) was implemented in August 2006 by the Australian Government, in partnership with state and territory governments, as part of its Strengthening Cancer Care initiative following the success of the Bowel Cancer Screening Pilot Program which ran from November 2002 to June 2004.
Program goals
The major goals of the Program are to:
- reduce the incidence and mortality of bowel cancer through screening to detect abnormalities of the colon and rectum at an early stage and
- where bowel cancer has developed, to detect cancers at an early stage in order to maximise the effectiveness of treatment.
Program components
The NBCSP is being phased in gradually to help ensure that health services, such as colonoscopy and treatment services, are able to meet any increased demand. The current phase of the NBCSP offers immunochemical faecal occult blood tests (FOBTs) for:
- initial screening of people aged 55 or 65 years between 1 May 2006 and 30 June 2008 (referred to as the National Program)
- rescreening of those people who participated in the Bowel Cancer Screening Pilot Program (referred to as Pilot participants)
- screening of people who were invited to participate in the Bowel Cancer Screening Pilot Program but declined the invitation (referred to as Pilot invitees).
Program outcomes
This is the first monitoring report produced by the Australian Institute of Health and Welfare on the performance of the NBCSP for the period 7 August 2006 to 31 July 2007. Data were provided by the National Bowel Cancer Screening Register maintained by Medicare Australia and are presented as indicators measuring program activity, performance, colonoscopy quality and outcome.
As the NBCSP comprises three population groups, analyses of the National Program implementation in 2006–2007 and the Pilot Program rescreening and re-invitation during the same period are presented separately.
Key facts
- There were a total of 475,198 invitations sent between 7 August 2006 and 31 July 2007. Of these 447,114 were to people aged 55 or 65 years and 28,084 to people involved in the Pilot study.
- After adjusting for lags between invitation and response using the Kaplan-Meier method, participation for those aged 55 or 65 years was estimated at 41.0%.
- Risk of bowel cancer increases with age. The crude participation rate in the National Program was higher for people aged 65 years (38.0%) than for people aged 55 years (31.8%).
- Males aged 55–74 years had a 58% higher incidence of bowel cancer than females in 2004 yet were less likely to screen. The crude rate of participation in the National Program was 31.2% for males compared with of 37.3% for females.
- As at 31 July 2007, there were a total of 155,839 people who had completed a FOBT analysed by pathology.
- Of those FOBTs analysed, 7.0% tested positive for blood in the sample.
- Positivity rates were higher for males than females in all three target populations. Of those aged 55 or 65 years who completed a FOBT, 8.4% of males tested positive compared with 5.9% of females.
- There were a total of 2,764 visits to general or other primary health practitioners as a result of a positive FOBT recorded during the period for all three target populations. Referral for colonoscopy was made in 91.5% of these consultations.
- There were a total of 2,283 colonoscopies following a positive FOBT result recorded for all three target populations.
- Pre-cancerous polyps, adenomas or cancer were detected in 62.8% of all positive FOBT results investigated by colonoscopy.