Population cancer screening: The basics

What is population cancer screening?

The Australian Institute of Health and Welfare (AIHW) describes population-based cancer screening as an “organised, systematic and integrated process of testing for signs of cancer or pre-cancerous conditions in asymptomatic populations”.9

In Australia, there are three national population-based screening programs:

National Bowel Cancer Screening Program
BreastScreen Australia
National Cervical Screening Program

These programs are run through partnerships between the Australian Government and state and territory governments. The programs aim to reduce illness and death from these cancers through the early detection of cancer and pre-cancerous abnormalities, and through effective follow-up treatment.

The programs target specific populations and age groups where evidence shows screening is most effective at reducing cancer-related morbidity and mortality.

Population cancer screening improves cancer outcomes

In 2018, the AIHW analysed the survival outcomes of people diagnosed with cancer to better understand the benefits of screening.1

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

Key findings include the following:

  • The risk of dying from bowel cancer was 40% lower for people aged 50–69 who were diagnosed through the National Bowel Cancer Screening Program than for those with bowel cancer diagnosed outside the program.
  • For women diagnosed with breast cancer, the risk of death was 42% lower among those diagnosed through BreastScreen Australia than those who had never screened.
  • Women whose cervical cancer was diagnosed through screening have an 87% lower risk of dying than those who have never undergone cervical screening.

High participation in cancer screening programs is needed to reap the greatest benefits in terms of reducing illness and death from these cancers.10

Cancer screening eligibility

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Population-based screening programs

Eligible participants: Men and women aged 50 to 74 years of age.

Screening process and test type:

  • Immunochemical faecal occult blood test (iFOBT) every two years.
  • Eligible persons receive the free screening test kit in the mail around the time of their birthday.
  • The screening kits are sent to the recorded Medicare address. The test kit is completed at home and sent back in the post to the pathology laboratory for analysis.
  • The iFOBT used in the program has a high degree of accuracy (estimated 83% sensitivity and 93% specificity).11

Key points:

  • Bowel cancer is the second-most common cause of cancer death in Australia and, if detected early, can be successfully treated in more than 90% of cases.12
  • Program participants had 15% less risk of dying from bowel cancer, and were more likely to have less-advanced bowel cancers when diagnosed, than non-participants.13
  • The National Health and Medical Research Council has endorsed the 2017 Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer. The recommended strategy for population based screening in Australia directed at those of average risk of bowel cancer and without relevant symptoms, is immunochemical faecal occult blood testing every two years, starting at age 50 years and continuing to age 74 years.14

For more information/to order resources:

Eligible participants: The BreastScreen program actively targets women aged 50–to74 years. It is available to all women aged 40 years and over.

Screening process and test type:

  • Mammogram every two years at a BreastScreen fixed site or the BreastScreen mobile van.
  • Bookings are made via phone (13 20 50) or online at breastscreen.nsw.gov.au
  • Women do not need a GP referral, but are more likely to screen when encouraged by their general practice.

Key points:

  • Screening and assessment is free for eligible women via the BreastScreen service.
  • BreastScreen mammograms are read by two to three radiologists specialised in breast cancer, using a closely monitored quality assurance process.
  • Women should only be sent to private providers when symptomatic.

For more information/to order resources: breastscreen.nsw.gov.au

Eligible participants:

  • The Cervical Screening Test is for women aged 25 to 74 who have ever been sexually active.
  • The Cervical Screening Test is for women who have had the HPV vaccination and those who have not been vaccinated.
  • Women are invited to take an exit screen from age 70 to 74. If the result is normal and there is no HPV, then the woman can exit the program.

Screening process and test type:

  • The Cervical Screening Test is recommended every five years if the results are normal (i.e. negative for oncogenic human papillomavirus (HPV)).
  • The Cervical Screening Test has two parts. The first is a test for oncogenic HPV. The second test, reflex liquid-based cytology (LBC), is automatically performed on the same sample if the HPV test is positive for any oncogenic HPV type. The results of the LBC help to inform management recommendations. Both samples are reported at the same time by the laboratory and a single result with recommendations is issued.
  • HPV causes 99% of cervical cancer.15 The Pap test used to look for cell changes in the cervix; while the new test looks for HPV, which can lead to cell changes in the cervix.
  • The Cervical Screening Test can be undertaken by GPs or practice nurses.
  • For patients that may have refused to screen, an alternative method of sample self-collection is available but patients must meet the following eligibility criteria: - be over 30 years of age and be at least two years overdue for their screening test; or - be over 30 years of age and have never had a screening test.16

For more information/to order resources:

The National Cancer Screening Register

The National Cancer Screening Register (NCSR) is an Australian Government initiative that will create a single electronic record for each person in Australia participating in the National Cervical Screening Program and the National Bowel Cancer Screening Program.

The National Cancer Screening Register

Healthcare providers can access participant data through the National Register or call 1800 627 701 to speak to a member of the Contact Centre team.

There are no current plans to include BreastScreen in the NCSR. BreastScreen results will continue to be sent from the local BreastScreen screening and assessment services (SASs).

All state and territory cervical screening registries have migrated to the NCSR. The Register serves three main functions for the National Cervical Screening Program:

  1. It sends invitation and reminder letters when tests are overdue
    Under the new screening pathway, Cervical Screening Tests are recommended every five years for participants who do not require any further tests. The recommended interval may differ for some participants, depending on the result of the previous test.
  2. It provides a safety net for when a person is at risk
    Most Cervical Screening Tests are normal, but in a small number of cases, the test result will be abnormal and a person needs follow-up tests or treatment. The NCSR notifies participants and their health care providers when information has not been received by the Register to indicate the person has been followed up. This helps to ensure continuity of patient care.
  3. It provides a history of cervical screening results
    The NCSR plays a vital role in giving health care providers access to a patient's cervical screening history. This helps to manage participants identified as being at risk. Medical scientists and pathologists use the Register to report Cervical Screening Tests and make recommendations for follow-up, taking into account previous test results. This quick start guide provides an overview of how primary health care providers can access patient information from the NCSR. Healthcare providers can access participant data through the National Register or call 1800 627 701 to speak to a member of the Contact Centre team.
Important!

Important!

Practice software should remain the ‘source of truth’ for a patient’s clinical history.

Learning opportunities

There are a range of learning opportunities for your practice team in relation to the bowel, breast and cervical screening programs. This includes a range of online education modules which are an excellent way for practice staff to improve their knowledge and competency in relation to cancer screening.

Learning opportunities

he NBCSP has a series of online training modules tailored for GPs, practice nurses and Aboriginal and Torres Strait Islander health professionals.

GP Education Series for the National Bowel Cancer Screening Program

A series of four short videos designed to provide GPs with a simplified approach to the NBCSP covering the following topics:

National Bowel Cancer Screening Program webinar for nurses working in general practice

A one-hour online seminar on bowel cancer, screening and how nurses working in general practice can approach bowel screening with patients.

Training module: Bowel screening, No shame – just a part of life

A one-hour online training module for Aboriginal and Torres Strait Islander health workers about bowel cancer, the NBCSP, and how to talk with patients about doing the test.

BreastScreen NSW practice visits

To arrange for a BreastScreen NSW professional to talk about breast screening at your practice, contact BreastScreen NSW.

Breast cancer treatment: Online modules for rural health professionals

Cancer Australia, in collaboration with the Australian College of Rural and Remote Medicine (ACRRM), has developed a series of online modules about breast cancer treatment and care for rural health professionals.

These modules are accredited with the following professional colleges:

  • ACRRM for one core continuing professional development point.
  • Royal Australian College of General Practitioners (RACGP) Quality Improvement and Continuing Professional Development Program (QI&CPD) for two Category 2 points.
  • Royal College of Nursing Australia (RCNA) for one continuing professional development (CPD) hour as part of RCNA’s Life Long Learning Program (3LP).

For more information, visit the Cancer Australia website.

The National Prescribing Service (NPS) hosts online learning modules titled ‘National Cervical Screening Program’.

The modules, funded by the Commonwealth Department of Health, provide online training for health care providers who conduct cervical screening tests and follow-up management in accordance with the changes to practice and the clinical pathway.

Health care providers can choose to do as many of the modules as they need/want to. Each module has been accredited for continuous professional development (CPD). Users will need to create their own account (or use an existing account if they have previously completed any online learning with NPS). Accounts and all courses are free of charge.

Modules cover the following topics:

  • Module 1: Cervical cancer
  • Module 2: Changes to the National Cervical Screening Program
  • Module 3: Communicating the importance of screening
  • Module 4: Screening in practice
  • Module 5: Understanding the cervical screening pathway
  • Module 6: Communicating test results and patient management

You can also access the Cervical Screening Upskilling for GPs three hour workshop offered by family planning in collaboration with the NSW Cervical Screening Program.