Controversial colonoscopy review may miss CRC in young


By Mardi Chapman

11 Sep 2023

A draft report from the MBS Review Advisory Committee Colonoscopy Working Group has recommended limiting direct access to colonoscopy to only FOBT-positive patients or those with rectal bleeding.

The recommendation under consideration, which requires further consultation, is to “separate the positive FOBT indication from MBS item 32222 and limit direct access to colonoscopy to only FOBT-positive patients or those with a positive history of blood in the stool”.

The Colonoscopy Working Group (CWG) suggested the change would improve equity of access to colonoscopy for people in rural/remote and low-socioeconomic areas by reducing the number of unnecessary colonoscopies performed and, therefore improve the capacity of the workforce to undertake more targeted procedures.

“However, it was noted this is a complex area, and changes to direct access colonoscopy provision could have negative consequences including increased costs for some consumers,” the report said.

“The CWG considered that all other requests for colonoscopy should be accompanied by a relevant medical history, documentation, and be reviewed by an endoscopist to assess suitability for the procedure.”

Speaking at AGW 2023, Associate Professor David Hewett, from Brisbane’s Colonoscopy Clinic and the University of Queensland told the limbic the recommendation didn’t sit easily against the growing burden of early onset colorectal cancer.

“I don’t think that the agendas are aligned. Clearly the Commonwealth thinks we’re doing too many colonoscopies…they’re saying that it’s being done on the wrong people, or at least we’re just doing too many symptomatic colonoscopies. But the problem is that symptomatic colonoscopies are who we should be targeting for young onset cancer.”

He told the meeting that the red flags for early onset CRC were rectal bleeding, abdominal pain, weight loss, melena, iron deficiency anaemia and a change in bowel habits.

Prompt evaluation was required to improve the average 6-month delay from symptom onset to diagnosis.

“I suspect they’re suggesting we shouldn’t be doing it on people who have nonspecific lower GI symptoms – that they should just be sat on and monitored for a while – but that’s exactly in opposition to what we possibly need to do with these young patients.”

He said the draft MBS Review Advisory Committee Colonoscopy Working Group report included other recommendations on reporting, recertification, endoscopy training and clinical decision support tools.

“And then there’s …[this] recommendation that it says requires further consultation, which is because, I think, it’s controversial. It suggests that it’s going to take out the faecal occult blood test inclusion for that item number… so it’s then going to suggest that anyone else who’s referred for 32222s has to have a consultation with a specialist first, which is extremely limiting and it’s going to put a massive load on us.”

Associate Professor Hewett said he knows of four gastroenterologists or trainees who have been diagnosed with bowel cancer, two of whom had since died.

AGW 2023 also heard from surgeon Dr Kat Goodall about her experience of being diagnosed with rectal cancer at a young age, the impact on her personal life and her surgical training.

Australian colorectal cancer screening guidelines [link here] are currently under review.

GESA will be responding to the draft MBS Review Advisory Committee Colonoscopy Working Group report.

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