Dr Cameron Bell
Bowel cancer screening kits would be offered over the counter at pharmacies and community health services under proposals to revamp the National Bowel Cancer Screening Program being considered by the Department of Health.
Run since 2006, the NBCSP continues to be dogged by low participation rates, with over 56% of the 5.7 million eligible patients failing to return a sample in 2018 and 2019.
A review of Phase 4 of the program (2015-2020) by Deloitte Access Economics completed last year found the current approach of sending postal invitations to potential participants was “broadly appropriate”, but said there were issues with the system given about 9% of invitees had not received a kit in the past two years.
Access to colonoscopies was another sticking point, particularly for patients in the public system who waited 77 days on average compared to 51 days for private patients.
The department is now consulting on the report’s recommendations, and seeking feedback from stakeholders on a discussion paper about the next phase of the NBCSP as it “evolves from an expansion focus to an optimisation focus.”
One proposal in the paper floats the possibility of “opportunistic provision of kits” within primary care. The mailouts themselves could also be improved to encourage collection and return of samples, according to the department.
It’s suggested adding an “action plan” for completion in kit instructions to reduce chances of patients procrastinating on collection as well as accessories like opaque bags for fridge storage of samples intended to overcome perceived hygiene concerns.
Additional reminders and a major education push to primary health providers are other ideas on the table, particularly in light of the shift from five-yearly to biennial screening back in 2020.
The review called for the screening entry age to be reduced from 50 to 45, although it stressed this would be limited to Aboriginal and Torres Strait patients.
Screening rates may be higher
Gastroenterologist Dr Cameron Bell, chair of the Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party, welcomed the consultation.
However, he stressed that while a participation rate of 43.5% appeared low, the picture was probably rosier in reality.
“There is much wringing of hands about ‘non-participants’ but there is an unknown quantum of people who are either doing FOBTs outside the national screening program or having screening or surveillance colonoscopies for other reasons,” Dr Bell said.
“So the true non-participation rate is likely to be much, much lower than the reported figure in my opinion.”
He added there may be reasons to be sceptical of any push to reduce testing ages in underscreened populations including Aboriginal and Torres Strait Islanders, particularly without evidence of earlier onset colorectal cancer in the group.’
“There is no reason at all to lower the age of first invitation to 45 in a population simply because that population is underscreened,” he said.
It comes after the US Preventive Services Task Force recommended dropping the start age for colorectal cancer screening across the board from 50 to 45 years last May.
This followed modelling which found that screening between 45 and 75 years would result in 42-61 cancers averted per 1,000 individual screened and 24-29 CRC deaths averted per 1,000 individuals screened.
An editorial in JAMA said most young-onset colorectal cancer deaths were in 45-49 year-olds, adding there were questions over whether earlier screening could be appropriate in some cases.
“Ultimately, optimal prevention and early detection of colorectal cancer among individuals younger than 45 years will require further research into the underlying aetiology and risk factors of young-onset colorectal cancer, which thus far remain elusive but are suspected to possibly be related to environmental exposures during early life,” the editorial said.
The Department of Health is accepting submissions on the NBCSP report until June 17.