Cancer screening and primary care: A quality improvement toolkit

This toolkit will guide your practice through the steps required to:

• establish accurate cancer screening participation rates
• identify patients who are overdue for screening
• establish an effective cancer screening reminder system
• deliver patient-centred care to those at increased risk of non-participation in screening.

What are the learning outcomes?

Once you have completed the toolkit, your team will be able to:

1. describe population-based cancer screening and the role of primary care in breast, bowel and cervical cancer screening
2. maintain accurate cancer screening data through the completion of data-cleaning activities, and the introduction of data management and organisational system changes
3. identify all patients who are eligible for bowel, breast and cervical cancer screening
4. develop, implement and sustain a reminder system for bowel, breast and cervical cancer screening
5. describe the population groups at increased risk of non-participation in screening and the strategies that primary care providers can undertake to improve participation among these patients in bowel, breast and cervical screening. 

Why is cancer screening so important?

People with breast, cervical and bowel cancers detected through national cancer screening programs have better cancer survival outcomes than those diagnosed who had never been screened.¹

In 2018, the Australian Institute of Health and Welfare (AIHW) conducted an analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia. This analysis revealed the following:

Bowel cancer

This study looked at people aged 50-69 who were diagnosed with bowel cancer between 2006 (when the screening program started) and 2012.

Finding: People with cancers diagnosed through the National Bowel Cancer Screening Program had a 40% lower risk of dying by 2015 than those who had not been invited during the study period.

Breast cancer

This study looked at women aged 50–69 who were diagnosed with breast cancer between 2002 and 2012.

Finding: Women with cancers diagnosed through BreastScreen had a 42% lower risk of dying by 2015 than women with cancers who had never been screened.

Cervical cancer

This study looked at women aged 20–69 who were diagnosed with cervical cancer between 2002 and 2012.

Finding: Women with cancers diagnosed through cervical screening had an 87% lower risk of dying by 2015 than women with cancers who had never had a Pap test.

Why do cancer screening rates need improving?

6 out of 10 eligible people are not participating in the National Bowel Cancer Screening Program

of eligible women are overdue for a screening mammogram

People from Aboriginal and Torres Strait Islander or culturally and linguistically diverse backgrounds are less likely to participate in bowel, breast and cervical screening.

4 out of 10

eligible women are overdue for cervical screening

Why is the role of primary care so important?

Patients who are reminded by their GP to attend cancer screening are more likely to screen.^2,3,4,5

Formative research conducted by the Cancer Institute NSW found that 60% of patients surveyed reported they were more likely to screen when reminded by their GP than when reminded by a registry only.²

General practices across NSW and Australia have completed cancer screening quality improvement projects to trial ways to improve cancer screening participation.

Practices participating in Cancer Institute NSW cancer screening quality improvement programs found that:

• many patients, including those who had never screened, were "falling through the gaps" of practice reminder systems
• patient surveys helped identify simple solutions, such as offering women's health clinics in the evening, helped boost screening rates
• cleaning up data revealed lower-than-expected cancer screening participation rates, and identified cohorts of under-screeners.

What can be found in this toolkit?

The Royal Australian College of General Practitioners (RACGP) has a resource, Putting Prevention Into Practice ('The Green Book'), which provides guidance on how to overcome the factors that can limit the effective delivery of preventative care.⁴

This toolkit puts together lessons and evidence from the cancer screening programs and the 'The Green Book' to give you a clear and easy-to-follow roadmap for improving cancer screening rates.

The toolkit is structured into five modules that can be completed at your own pace. 

As a guide, aim to complete one module per month. Each module begins with a work plan that guides you through implementing the module.

Depending on your practice’s needs, the toolkit can support 'fine tuning' of existing systems, or creation of whole new approaches to cancer screening.