Bowel Cancer Screening

With the release of the 2014-15 Federal Budget, Bowel Cancer Australia welcomed an extra $95.9 million in funding committed to expand The National Bowel Cancer Screening Program. The expansion is to be introduced in stages, with all Australians aged over 50 years expected to be eligible for free bi-annual screening by 2020.

This program represents a significant investment in Australian health, as Australia has one of the highest rates of bowel cancer diagnoses in the world. Bowel cancer is the second biggest cancer killer in Australia, claiming the lives of almost 4,000 people each year.

Early detection is the key for a favorable outcome. If treated early, bowel cancer has a five year survival rate of approximately 93%. This figure drops to just 8% for patients who present with widespread disease.

These statistics highlight the importance of early intervention. Unfortunately bowel cancer often presents no detectable symptoms in the early stages. Therefore, this screening program has the potential to significantly lower the mortality rate of the disease via earlier diagnosis. Research suggests that The National Bowel Cancer Screening Program could save up to 500 lives per year. In addition, there is potential for a significant reduction in morbidity, as patients who present earlier can receive less intensive treatment.

For example, a patient presenting for a colonoscopy following a positive faecal occult blood test (FOBT) may simply have small amounts of blood loss from benign polyps. This can be easily treated during a colonoscopy procedure, without the need for surgery at all. In contrast, if that same patient had not undertaken a FOBT, over time some of the polyps may become malignant. By the time symptoms are noticed by the patient, the treatment may involve surgical resection of the bowel, chemotherapy, or both.

Immunochemical FOBTs are used in this program as, unlike the guaiac FOBT, they are not affected by diet or medicines. The tests can be performed at home by the patient, with the results sent in to the laboratory for analysis. The test is non-specific as it only aims to identify blood in the stools. A positive result would require further investigation, usually including a colonoscopy, to identify the source of the blood. A negative test result is not conclusive, as bowel cancers and pre-cancerous lesions may only bleed intermittently. Therefore, patients should be advised to report any symptoms to their doctor and be reminded of the importance of regular screening.

Symptoms that patients should be aware of are: blood in the stool, any persistent changes to their bowel habits, vomiting, unexplained weight loss, tiredness, or persistent abdominal pain.

The screening program is currently underutilised, with below 50% of eligible participants taking part. In addition, data from the Hunter Community Study suggests that a staggering 20% of patients with symptoms of bowel cancer have not consulted their doctor. This presents all health care workers with an important opportunity to educate patients and help raise awareness of this disease. If screening programs are more readily accepted and people more open to discussing their symptoms, the morbidity and mortality rates of bowel cancer could be drastically reduced.