National Bowel Cancer Screening Programme

Mixed messages have caused confusion amongst general practitioners for many years and the level of awareness for the general public has been poor. The Federal Government has failed to provide an Awareness programme for the general public and the Faecal Occult Test for blood in the bowel motion is available to people of 50, 60 or 65 once only; the test  identifies blood in the bowel motion and its success relies entirely on it ideally being repeated at two yearly intervals.

Participation rates have been 43% (almost certainly because of lack of appropriate preliminary awareness information) but similarly a significant proportion of early pathology has been identified, thus saving lives. Those who are selected from the Medicare Register for testing and who have returned positive results (which have been found to be due cancer) have generally had earlier (and thus more often curable) cancers.

Importantly, FOBT was provided once only in the patient's lifetime. Clearly this is totally inappropriate for a test which aims to find blood (not polyps or cancer) and if the lesion is not large enough to bleed then the pathology is missed and repetition is therefore essential.

However, excellent results are derived from FOBT repeated every 2 years and provided from age 50 onwards. Pressure from the Bowel Cancer Foundation and Bowel Cancer Australia, together with the Cancer Council, have caused Minister Roxon to indicate that such a programme structure will be looked at for re-introduction in the next budget (mid 2011).

Clearly, colonoscopy is the optimal assessment given that FOBT misses 12% (or 1 in 8) cancers. It is more invasive and more expensive. It is however the appropriate investigation when clinical symptoms or relevant history warrant its use. A further point of interest and concern is that 10% of bowel cancers are now found to occur in those under 50 in the USA and UK and figures are now the same in Australia. Thus, attention now needs to be paid to determining optimal  assessment options from age 40.