Bowel Cancer
Program Officers
Lauren Walker | l.walker@cesphn.com.au
Stephanie Walker | s.walker@cesphn.com.au
Australia has one of the highest incidences of bowel cancer in the world. Around 17,000 people are diagnosed each year. It is the second most common cause of cancer mortality (after lung cancer), yet, if detected early 9/10 cases of bowel cancer can be successfully treated.
Bowel cancer can be present for some years before the individual shows any obvious signs of disease. However, non-visible bleeding of the bowel can occur from the pre-cancerous phase (the presence of benign polyps). This and the fact that bowel cancer exhibits a relatively slow progression has lead bowel cancer to be identified as pertinent for a population-based screening strategy.
Population screening is the ‘use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms’ (WHO 2015). Randomised controlled trials have clearly established that screening asymptomatic populations with immunochemical faecal occult blood testing (iFOBT) biennially reduces mortality due to bowel cancer.
Screening target group: Non-symptomatic men and women aged 50-74yrs considered average risk for bowel cancer.
Screening frequency: Every 2 years
National participation rates are around 41%. NSW participation rates however are lower than this and some parts of the CESPHN region have participation rates below 30%. If rates can be increased to 60% over 83,800 lives can be saved. Promotion within general practice is key.
The National Bowel Cancer Screening Program (NBCSP) was launched in 2006 to address the rising incidence of bowel cancer and significant mortality due to bowel cancer. In line with national programs in other countries, the NBCSP sends out faecal occult blood testing kits to the homes of the population when they reach 50 years and then will be sending them every two years from then on in until age 74 (the program has been phasing in 2-yearly screening and by 2020 this will be complete).
The test is completed at home as per the instructions included in the kit and sent to the laboratory free of charge. Results are provided to the individual directly, as well as to their nominated GP (individuals must document their GP details on the form) and data is collected on the National Register . Those who receive a positive test result are advised to speak to their GP and the Participant Follow up Function is activated by the NBCSP to ensure that participants testing positive have been followed up appropriately.
However, the key to the success of the program and reducing mortality rates for the population relies on the population actually participating by completing the samples and sending them back to be analysed. Participation rates in New South Wales are poor (ranking 7th of the 8 states) with an estimated 33.2% of the eligible population completing the samples.
There are multiple reasons why participation is so poor, and these may include: language issues, a disconnect from the national Program and the populations normal health providers and confusion over how the program functions. There are however identified enablers. A key enabler for the success of the program is the involvement of general practice and this has been recognised by all relevant stakeholders.
Help increase cancer screening participation in your practice for your population
The GP Endorsement letter
There is one evidence- based initiative which is the use of a GP endorsement letter. This is a letter that is sent out from the GP practice to the eligible population, before their 50th birthday, that is essentially, a recommendation from the practice GPs that the patient participate in the bowel screening program when the kit arrives.
This letter has been shown to increase participation rates significantly when tested in Australia . Feedback from population surveys confirm that GP endorsement is key for them to participate. It is a simple measure that may have a great impact on outcomes.
Please see a template of the letter here : http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/gp-template-letter
This could be sent as an email or letter. The NBCSP would consider formatting a SMS message, if this would be useful for your practice please
The 45-49-year-old health check (MBS item)
As has been recommended by the NBCSP and the Cancer Institute, this health check could be the perfect opportunity to discuss bowel cancer screening (which is not mentioned on some of the software templates for this health check and could be added) or at least to hand out a resource to improve health literacy around cancer screening programs before the age of 50 years.
Although this does not align perfectly with the screening start age for bowel (or breast) cancer which is 50 years it could function very well as a preparatory explanation of population-level screening programs.
Could your patients be invited for this health check in their 49th year?
Quality Improvement activities for cancer screening data are also important. If your practice would like to would like to commence a QI activity (relevant for QI PIP) relating to bowel, breast or cervical screening, please
Usual resources for general practice include:
- Clinical practice guidelines for the prevention, early detection and management of colorectal cancer (2017): Short Form: https://wiki.cancer.org.au/australiawiki/images/e/ed/Colorectal_cancer_guidelines_short_form.pdf
- NBCSP How to improve participation in your practice: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/role-of-GPs
- NBCSP: pdf Frequently asked questions about the program (101 KB)
- NBCSP website for resources: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-screening-1
- Cancer Institute NSW website for other resources: https://www.cancerinstitute.org.au/
- New National Bowel Screening Kit: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/NBCSP-test-kit
- Provision of Payments: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/information-on-provision-payments
Help increase cancer screening participation in your practice for your population.
GP endorsement letter
There is one evidence- based initiative which is the use of a GP endorsement letter. This is a letter that is sent out from the GP practice to the eligible population, before their 50th birthday, that is essentially, a recommendation from the practice GPs that the patient participate in the bowel screening program when the kit arrives.
This letter has been shown to increase participation rates significantly when tested in Australia . Feedback from population surveys confirm that GP endorsement is key for them to participate. It is a simple measure that may have a great impact on outcomes.
Please see a template of the letter here : http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/gp-template-letter
This could be sent as an email or letter. The NBCSP would consider formatting a SMS message, if this would be useful for your practice please
The 45-49-year-old health check (MBS item)
As has been recommended by the NBCSP and the Cancer Institute, this health check could be the perfect opportunity to discuss bowel cancer screening (which is not mentioned on some of the software templates for this health check and could be added) or at least to hand out a resource to improve health literacy around cancer screening programs before the age of 50 years.
Although this does not align perfectly with the screening start age for bowel (or breast) cancer which is 50 years it could function very well as a preparatory explanation of population-level screening programs.
Could your patients be invited for this health check in their 49th year?
Quality Improvement activities for cancer screening data are also important. If your practice would like to would like to commence a QI activity (relevant for QI PIP) relating to bowel, breast or cervical screening, please
Usual resources for patients include:
- How to do the test: VIDEO: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign-pr-video#2018-Using-the-kit
- Video available in Arabic, Chinese, Greek, Italian, Tamil and Vietnamese here and scroll down: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign
- Patient Information Booklet in 22 languages: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign
- Access resources by language: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/in-your-language
Screening resources for people with an intellectual disability-FPNSW have produced some excellent resources relating to the 3 screening programs
Cervical, breast and bowel screening is important for all people, but we know that people with intellectual disability are not screened as often as they should be.
Just Checking is a project funded by Cancer Institute NSW to help address this health inequality.
On this website you will find a range of resources designed by and for people with intellectual disability. There are also resources specifically for support workers, parents and carers to build their confidence in supporting people with intellectual disability to access cancer screening.
Usual resources for patients include
How to do the test: VIDEO:
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign-pr-video#2018-Using-the-kit
Video available in Arabic, Chinese, Greek, Italian, Tamil and Vietnamese here and scroll down:
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign
Patient Information Booklet in 22 languages:
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-campaign
Access resources by language:
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/in-your-language
This new service improves the timeliness of colonoscopies for patients with positive FOBT. This will be done by getting fast access to the colonoscopy lists for patients in the public hospital, using a telephone Nurse-Led clinic model. The CNC will liaise with Gastroenterologists on your behalf to facilitate quick response for your patients, with the CNC your first point of call if you have any concerns.
Advantages:
- Reduced wait time between a +ve FOBT and outpatient colonoscopy within the public hospital setting.
- Streamlined, fast effective access to colonoscopies for outpatients.
Suitable referrals:
- Direct referrals from GP’s of asymptomatic +ve FOBT patients OR
- Patients who have had previous cancer or polyp resections, and are due for their follow-up colonoscopies.
Please contact: Sarah Rolls (Gastro CNC)
Ph: 9113-2194 Fax: 9113-1290
Gastroenterology/ Hepatology Department, St George Hospital
Or FAST TRACK REFERRAL FORM available pdf here (283 KB)