Introduction to bowel cancer and bowel screening

About bowel cancer

1 in 11 men
1 in 15 women

in NSW will be diagnosed with bowel cancer during their lifetime

1 in 13

people in NSW will be diagnosed with bowel cancer by age 85

of bowel cancers in NSW are found in people 50 years and over

Bowel cancer is Australia's second-biggest cancer killer

• Bowel cancer can also be described as colorectal cancer, colon cancer, rectal cancer or anal cancer, depending on the section of bowel where the cancer starts.
• Bowel cancer is Australia’s second-biggest cancer killer.
• 1 in 13 people in NSW will be diagnosed with bowel cancer by age 85.
• In NSW, 91% of bowel cancers are found in people aged 50 years and over.
• In NSW, one in 11 men and one in 15 women will be diagnosed with bowel cancer during their lifetime.

About the National Bowel Cancer Screening Program

• The National Bowel Cancer Screening Program (NBCSP) is a Commonwealth Government-funded population-based screening program.
• People aged 50 to 74 years who have a valid Medicare card or registration with the Department of Veterans Affairs are invited to participate.
• The free immunochemical faecal occult blood test (iFOBT) kit is sent to eligible participants by post around the time of their birthday.

• From 1 January 2019, people aged 50 to 74 will receive an invitation to participate every two years.
• The iFOBT is the recommended screening tool for people at average risk (or at slightly above average risk) of bowel cancer in Australia.
• The iFOBT is the gold standard for screening asymptomatic patients. Its benefits include the following:
  • 99.9% negative predictive value
  • 3.6 positive predictive value
  • 85% sensitivity
  • 92% specificity
  • Non-invasive procedure with low associated risk to the patient
  • Dietary and medication modification are not required
  • Highly cost-effective

The role of general practice

The NBCSP provides excellent information, links, resources and templates about the role of primary care in bowel cancer screening:

• The role of general practitioners and practice nurses in the NBCSP.
• Online training and clinical resources.
• How general practice can support increased participation in the NBCSP (including reminder letter and SMS templates, and patient resources).
• Clinical guidelines and screening pathways.
• Understanding the test and explaining it to patients:
  • Demonstration kits are available to order from NBCSP@health.gov.au
  • Online instructional videos
  • Written Home Test Kit instructions in a number of languages
• The ‘Promotional materials’ section of the NBCSP website has links to a range of resources, including:
  • promotional materials designed for mainstream audiences, including brochures, posters and flyers
  • booklets and videos for people with intellectual disability or low health literacy
  • materials in 22 languages, and a flipchart and facilitator’s manual for engaging culturally and linguistically diverse people in bowel screening
  • a range of print and audio materials for Aboriginal and Torres Strait Islander people.

The need to improve bowel cancer screening participation

• Bowel cancer is common—it kills more people in NSW than prostate cancer, breast cancer or melanoma.²³
• If found early, more than 90% of bowel cancers can be successfully treated.¹³
• In NSW, only 38.2% of eligible people take part in the National Bowel Cancer Screening Program.²⁴
• Screening rates are consistently lower in men, Aboriginal, Torres Strait Islander and immigrant populations.

Annual bowel screening participation rate* for people aged 50–74, by primary health network (PHN) (ranked), NSW, 2016 and 2017

N = Number of invitations sent, 2017.

* The participation rate is the proportion of the eligible population invited to the National Bowel Cancer Screening Program (NBCSP), who returned a completed immunochemical faecal occult blood test (iFOBT).

Notes:

1. Data Source: National Bowel Cancer Screening Program Reporting Portal, June 2018.
2. Participation rates shown in this report vary slightly from data published by the Australian Institute of Health and Welfare, due to variations in methodology.

Bowel screening rates

If bowel screening participation rates in the National Bowel Cancer Screening Program increased to 60%, almost 83,800 lives could be saved from bowel cancer over 25 years. [25]

Participant Follow Up Function (PFUF)

• The Participant Follow Up Function (PFUF) is a function of the NBCSP, performed by the Cancer Institute NSW (pillar of NSW Ministry of Health).
• PFUF Officers support participants to progress through the bowel cancer screening pathway, following a positive iFOBT result.
• Program letters are sent to participants and their nominated GP to provide iFOBT results; to prompt GP visits and referrals.
• Following reminder letters, PFUF Officers conduct follow-up calls to participants and their nominated GP where a participant has not progressed along the pathway according to the National Cancer Screening Register.
• Participants and nominated GPs can inform the Register of pathway progress by returning Program forms (e.g. GP Assessment Form following a consult) or contacting the Infoline (health professional option) on 1800 118 868.

For information regarding the NSW PFUF service, email CINSW-BowelScreening@health.nsw.gov.au