GI cancer

Bowel cancer screening program moves beyond mailouts

The National Bowel Cancer Screening Program (NBCSP) is now providing healthcare providers with free iFOBT bowel screening test kits to give directly to patients as an alternative to the to the existing mailout model.

Under a new alternative access model commencing 31 October 2022, healthcare practices will be able to bulk order iFOBT screening kits to issue to patients, so long as they register to provide testing data via the National Cancer Screening Register.

The aim of the new model is to overcome the barriers to bowel screening inherent in the mailout-based system for self testing at home, which has seen participation rates among the 5.7 million people invited to screen annually languish at around 44% in the 50-74 year target age group.

“Talking with a healthcare provider or trusted person can be key in helping people decide to do the bowel screening test and will help increase low screening rates in some community groups,” the Department of Health states in its information to healthcare providers accompanying the new program.

To be eligible to participate, healthcare practices must register for access to the National Cancer Screening Register Healthcare Provider (HCP) Portal so that they can submit participant details and access and manage screening data.

Through the Portal, healthcare providers will receive reminders to encourage their patients to return test kits, as well as notifications of test results and follow up actions where applicable.

If a patient has a positive FOBT they and their nominated healthcare provider will be mailed a copy of the results, and an alert will appear in the HCP Portal against the patient’s record. A doctor will likely refer the patient for further diagnostic testing such as a colonoscopy.

Practices are advised not to bulk order more than 30 iFOBT kits at a time, noting that they have an expiry date of around seven months.

The Alternative Access Pathway was one of the recommendations of a major review of the NBCSP conducted in 2021. It advised using the primary care sector as a resource to promote participation through education and opportunistic provision of kits, and expanding the Alternative Pathway pilot programs that targeted at Aboriginal and Torres Strait Islander people, to address access barriers faced by other groups such as people from CALD backgrounds.

The Department of Health notes that the alternative access model was successful in ‘closing the gap’ in bowel cancer screening rates when assessed in a pilot trials in 44 Indigenous health service providers. The pilot achieved a participation rate of 40 per cent (similar to the overall Program participation rate), compared to 23 per cent in the traditional screening pathway.

The 2021 review found that the mailout model for iFOBT screening was ‘broadly appropriate’ but that participation rates could potentially be improved by alternative models in some underscreened population groups.

The review also found that the diagnostic assessment rate (66%) was low possibly due to underreporting “as there is no reporting obligation for colonoscopy providers to provide information to the NCSR about Program participants.”

It also noted there were ongoing challenges with timely access to a publicly delivered colonoscopy for NBSCP participants, with 58% of gastroenterologists practising in the private sector.

“The median time to diagnostic assessment in 2018 was higher than the benchmark in the NBCSP Quality Framework (51 days and 44 days, respectively), and notably worse for participants treated in the public system (77 days),” the review noted.

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