Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

The Australian National Bowel Cancer Screening Program (#313)

Finlay Macrae 1
  1. Head, Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia

Australia has one of only a few population-based bowel cancer screening programs in the world, and the first which uses an immunochemical faecal occult blood test as the screening methodology.

As of the last AIHW report1 (June 2012, reporting results to June 2011), over 4 million Australians had been invited. Since the introduction of the offer to 50 year olds, 38% have accepted with 7.8% positive tests identified (62000). For 71% of these, data from colonoscopy reached the central register. Amongst the positive screenees, there are 1121 had suspected or confirmed cancers reported to the register and 3333 advanced adenomas. 80% of the cancers were localized.

The strengths of the NBCSP are its population reach regardless of English spoken or other factors, acceptable participation rates, high compliance with follow-up colonoscopy, and demonstrable yields of early colorectal cancers and advanced adenomas.

Weaknesses of the NBCSP are the limited roll out of the program to date, the incomplete (though still high) colonoscopy reporting rates, and the very poor pathology reporting rates to the central NBCSP.

Stage Shifting: Independent academic studies2,3  have reported statistically significant and favourable stage shifts for the screen detected, vs other cancers, both at a population level (SA), and surgical oncology outcome database level, stratified by ascertainment (NBCSP+ vs Other).

Australia can be deservedly proud of its NBCSP, and is in envy of the many countries where there has not been a commitment to implement population based-screening programs.

However, there is room for improvement:

· Full implementation of the NBCSP for all Australians 50 to 75 years of age, q 2 yearly.

· Investment in the IT processes to ensure pathology reporting is deposited on the NBCSP database.   This requires the Commonwealth and States to tango.

· Pathway navigators should be employed in all states, not just Qld, Vic and SA.

· The NBCSP must be more receptive to research opportunity. There will be better tests for CRC screening. The infrastructure of the NBCSP provides as ideal test bed to compare he old with new technologies. If we are to be smart, we need to build research into the NBCSP.  

· Cost benefit, even saving, analyses

  1. AIHW: National Bowel Cancer Screening Program Monitoring Report Phase 2 July 2008 to June 2011. www.aihw.gov.au/WorkArea/Asset.aspx?id=10737421401
  2. Ananda SS, McLaughlin SJ, Chen F et al. Impact of the Australian National Bowel Cancer Screening Program. Med J Aust 2009 191 178-81
  3. Cole S et al. Presented to Australian Gastroenterology Week, 2011. In press