Bowel screening is a simple test your client does at home.

The Australian Government provides free bowel cancer screening kits every two years to eligible Australians aged 45 to 74 years. 

There are now two ways to access a kit:

1. Mail-out model – kits are mailed directly to eligible people by the National Cancer Screening Register

• Medicare and Department of Veterans’ Affairs provides a list of people who are aged 50 to 74, so that a kit can be mailed out to them automatically. People aged 45-49 are also eligible to receive a free bowel screening test kit by request.
• If your client gets a kit in the mail, remind them to do it as soon as they can. It’s a good idea to put the kit in the bathroom as a reminder.
• The test kit expires after approximately six months. If it has expired, a replacement kit can be requested from the National Bowel Cancer Screening Program. The expiry date can be found on the back of the kit.

2. Alternative access to kits model – healthcare providers give kits directly to eligible people, explain why the test is important and demonstrate how to do it.

Healthcare providers can now bulk order kits and issue them directly to eligible patients during an appointment.

This model was developed and piloted to address barriers to screening for Aboriginal people and due to its success in increasing participation has been rolled out more widely.

Find out more about the alternative access to kits model by visiting:

• National Bowel Cancer Screening Program website
  This website includes background to the model, an alternative access to bowel screening kits guide and relevant training and resources.
• National Aboriginal Community Controlled Health Organisation (NACCHO) website
  This website includes culturally appropriate training and contacts for Aboriginal Community Controlled Health Organisations (ACCHOs) participating in the model.

If your client hasn't been sent a kit

Your client may not have received a kit if their details are not up to date in the National Cancer Screening Register.  

To organise a kit to be sent to your client, there are a few steps you can take:

1. If you think your client is due for a bowel screening kit, call the National Cancer Screening Register on 1800 627 701 or go to the online order form to find out if they’re eligible.  
2. If your client is due for a kit, request another kit to be sent to them. If you work in primary care, your health service may have access to the National Cancer Screening Register Healthcare Provider Portal. In the portal, health professionals can see their patient’s bowel screening history and, if appropriate, order them a new kit. 
   *Note – please make sure you read the training guide before issuing kits.
   **Note - Timing can vary when reordering a kit. Please double check that the client's details are up to date and follow up directly with the National Cancer Screening Register if they do not receive a kit in the mail.

The National Cancer Screening Register has more information.

Get help to register from an expert advisor at the National Cancer Screening Register by using their call-back form.

The bowel cancer screening test is a simple test that your client can do at home.

The test is designed to find tiny traces of blood in the poo, which can be a sign of changes in the bowel.

For the test, your client will do the following:

Collect samples of their bowel motions (poo)

The test comes with an instruction sheet that explains how to do this. 

 

Send the samples for testing

Put the samples in the provided reply-paid envelope with the Participant Details Form and send the envelope in the post.

Your client should repeat the test every two years from age 45. 

For more information on doing the test:

• watch instructions on how to complete the kit 
• download the home test kit instructions.

The results are sent to your client and the doctor or health service they choose. 

This usually happens within two weeks.

A negative test means no blood was found. They should do the test again in two years. 

If your client develops symptoms, they should see a doctor before their next test.

A positive test means blood was found but the test does not show what’s causing the blood to be there. It doesn’t necessarily mean they have cancer—it could be from other conditions. 

The most important thing to do is to see the doctor and find out why there is blood in the poo. The doctor will likely do a check-up and more tests. 

If your client's test results come back positive, their doctor will probably refer them for a colonoscopy. 

A colonoscopy is a procedure to look inside the bowel. It’s usually done in a hospital under a light sedation so the patient won’t feel anything.

A doctor inserts a narrow flexible tube with a tiny camera into the rectum to look for polyps or cancerous growths.  

The day before the colonoscopy your client will need to have a special drink to help empty their bowel. They’ll need to be near a toilet for the day.

They may need to take time off work or plan ahead if they need to travel for the procedure.

Your client should ask their doctor about their options and any costs that may be involved when booking a colonoscopy.

There are three main ways to access a colonoscopy in NSW:

• The Direct Access Colonoscopy (DAC) service of a public hospital 
  Most patients will be assessed over the phone prior to the day of the colonoscopy. There will be no out-of-pocket costs to the patient. More details below.
• The outpatient gastroenterology clinic of a public hospital
  The patient will need to attend the hospital in person to be assessed prior to the day of the colonoscopy. There will be no out-of-pocket costs to the patient if the colonoscopy is then done in a public hospital.
• A private specialist’s rooms
  The patient will typically need to be seen in person to be assessed prior to the colonoscopy which often incurs an out-of-pocket cost. 

Direct Access Colonoscopy (DAC) service

A DAC service is part of the NSW Health system. It improves access to colonoscopies for people in NSW who have a positive bowel cancer screening test result by reducing barriers commonly faced by patients like:

• out-of-pocket costs to see a specialist before the colonoscopy
• time spent travelling to see the specialist
• time off work
• long wait times for the colonoscopy procedure.

If your client is referred to a DAC service, a specially trained nurse will assess them over the phone before the procedure. 

The nurse will:

• ask some questions to make sure your client is suitable for the service 
• book a time for them to have their colonoscopy. 

This phone appointment is free. 

Patients will only need to attend the clinic or hospital once, on the day of their procedure. 

If your client isn’t suitable for the DAC service, they’ll still need to see a specialist in a face to face clinic. They’ll need to make an appointment with a specialist before their colonoscopy. 

Click here for more information and a list of DAC services in NSW. 

For more information of eligibility, consider using Refer4Scope, an online decision tool to support assessment, triage, and referral for colonoscopy services by primary care practitioners.

Under 45 years

Although the vast majority of people diagnosed with bowel cancer are 50 years or older, it also occurs in younger people. Screening is recommended from age 45, so the free bowel cancer screening test is now being offered to 45-49 year olds.

If your client is under 45 and is concerned about bowel cancer, the best thing to do is to encourage them to speak to their doctor. They'll get tailored screening advice based on their situation.

Over 74 years

The main reason the National Bowel Cancer Screening Program stops at age 74 is that people over this age have a greater risk of complications from the follow-up procedures used for bowel cancer screening (such as colonoscopy).

This means it's best for your client to speak to a doctor who can recommend the best option for them which considers any potential risks and benefits.

• Australian Commission on Safety and Quality in Healthcare has colonoscopy resources for Aboriginal and Torres Strait Islander people.
• SA Health has culturally appropriate resources including What happens next? If your bowel screening result is positive for Aboriginal men and women. 
• Sydney Local Health District has a culturally appropriate video on preparing for a colonoscopy for Aboriginal men and women.
• Information flyer on colonoscopy referral options (including Direct Access Colonoscopy) for GPs and patients. 
• Refer4Scope – Colonoscopy Referral Decision Tool supports healthcare professionals to assess their patient’s referral pathway to colonoscopy in just a few clicks. GPs can follow the quick and easy prompts to input their patient’s screening test outcomes, age, family history and bowel symptoms to receive the recommended next step.

Most times there are no obvious early signs or symptoms of bowel cancer. 

Doing a bowel screening test is important even if there are no obvious symptoms. 

Symptoms can include: 

• blood on the toilet paper or in the toilet after a poo
• feeling very tired for no reason 
• iron deficiency (this is called anaemia) 
• changes in normal bowel habits, e.g., looser poo or straining to do a poo
• tummy pain for no reason
• loss of weight for no reason. 

Having these symptoms doesn’t mean your client has bowel cancer, but they should follow up with a doctor as soon as possible. 

Most (9 out of 10) people do not have a significant family history of bowel cancer.² Age is likely to be the biggest risk factor so it's critical that all people aged 45-74 do a bowel screening test every 2 years.

Encourage your clients to talk to a doctor about their risk of getting bowel cancer and what testing is right if they have a family history of bowel cancer. This includes having one close relative who developed bowel cancer under 60 years of age (for example, a parent, brother, or sister); or having more than one close relative who had bowel cancer at any age.

People who do not know their family history should talk to their doctor if concerned.

See the clinical practice guidelines for a summary of recommendations on risk and screening based on family history.

See Cancer Council Australia for more information on family history and cancer.

If your clients get a free screening kit in the mail, encourage them to use it as soon as possible.

Doing a test every two years is one way to stay healthy, strong and deadly.

This test can save lives, so spread the word:

• Help break down the stigma around talking about topics like ‘poo’ and ‘cancer’. Use the National Bowel Cancer Screening Program – Checklist to guide your conversations.
• Explain why the test is important and order a demo kit to show how to collect the samples.
• Remind your clients to do their kit—keep some instruction sheets on hand to reinforce the message.
• If your client hasn’t done a kit in the past two years, offer to arrange a kit for them.
• If you’re a primary care provider, do the training and register to distribute kits via the National Cancer Screening Register Healthcare Provider Portal. If you need help, arrange a call-back.
• If you run 715 health checks with clients – remember to ask those over or near 45 years of age about their bowel cancer screening status. See the RACGP site for 715 Health Check templates that cover cancer screening status.
• Learn more about how to talk about bowel screening with community using the Understanding bowel screening – Flip chart guide for Indigenous people.

Find out more about the National Bowel Cancer Screening Program or call the information line on 1800 627 701.

We've designed and collated resources to help you promote bowel screening with your community:

• Top recommended bowel screening resources – a selection of recommended resources to support you in encouraging bowel screening participation.
• Practical tools for having a yarn – downloadable and printable resources we've created to help guide your conversations about screening and hand out to community.

Being told you have cancer is a scary and confusing time for people. Knowing what to do next, who might be able to help and where to get easy to understand information is important for both the individual, their family and you as a support person.  

Here are some trusted websites that talk about a bowel cancer diagnosis, treatment options, treatment side effects, the sharing of cancer stories and getting further support:

• All about cancer for Aboriginal and Torres Strait Islander peoples (Cancer Council NSW) - cancer information for Aboriginal and Torres Strait Islander people.
• Our Mob and Cancer (Cancer Australia) - a website developed for mob, by mob to help find information about cancer, prevention, diagnosis, treatment, living with cancer and much more.
• Canrefer (Cancer Institute NSW) - a site that helps find recommended cancer specialists, hospitals and cancer care teams in your area.
• Cancer treatment side effects: A guide for Aboriginal Health Workers (Cancer Institute NSW) - a guide to help you support your clients going through cancer treatment by learning more about the different types of cancer treatments, their side effects and when to seek help.