Making bowel cancer history with the national bowel cancer screening program

Australia has one of the world’s highest rates of bowel cancer, with more than 16,000 new cases and over 5,000 deaths each year, making it our second biggest cancer killer. But this could be about to change.

In 2020 we saw the full implementation of Australia’s National Bowel Cancer Screening Program and an opportunity to save 84,000 lives over the next 25 years. With the help of people like you, we can finish this story of research, advocacy, patience and determination.

LOOKING FOR WAYS TO FIND A HIDDEN KILLER

Cancer Council’s connection with bowel cancer screening dates to the 1970s, when researcher and adviser to Cancer Council Victoria, Professor James St John, began experimenting with tests to find the disease in early, treatable stages.

Cancers and precancerous polyps in the bowel often leave tiny traces of blood in poo. Professor St John and colleagues in Melbourne worked day and night evaluating candidate tests and testing strategies that could efficiently detect this blood from a sample to screen people at risk but without symptoms.

For twenty years, the researchers tried multiple methods to find blood hidden in poo in a way that meant it could be detected via screening. In addition, in 1996, three international randomised controlled trials – the Holy Grail of medical research – conducted in USA for the UK and Denmark, showed that an early version of the faecal occult blood test for bowel cancer could save lives across a population.

FROM A CLINICAL TRIAL TO A NATIONAL PROGRAM

By the late 1990s, the Australian Government had already introduced screening programs for cervical and breast cancers, which Cancer Council was actively promoting. A screening program for bowel cancer, however, was a different prospect; the test would be done at home and it would be the first screening program for men as well as women. It was also focused on a cancer that caused a lot of deaths but had no public profile.

As an independent charity, Cancer Council successfully pushed for government to conduct bowel cancer screening pilots, and in early 2004, a report on the pilots showed that a screening program could work. By chance, this was also a federal election year, and introducing a bowel cancer screening program was at the top of Cancer Council’s election priorities.

The re-elected Howard Government responded with a commitment to introduce the National Bowel Cancer Screening Program’s in the 2005-06 federal budget. Australians turning 55 and 65 from August 2006 would receive a one-off free bowel cancer screening kit in the mail - but how this modest starting point would transition to the recommended two-yearly testing for all Australians aged 50 to 74 was unclear.

Soon, another election loomed – and a complete bowel cancer screening program was a key election priority for Cancer Council. The Rudd Opposition committed to adding 50-year-olds to the program as the first step to full implementation - but with no program completion date. The Opposition then became government, and 50-year-olds began to receive their kits.

ADVOCATING FOR A NEGLECTED CANCER

In 2012 Cancer Council submitted a $50 million proposal to Treasury, for 60 and 70-year-olds to be added to the program, and called on all politicians to support full implementation by 2020.

While the federal budget was under pressure due to the Global Financial Crisis, three influential Independent MPs, Tony Windsor, Rob Oakeshott and Andrew Wilkie, organised a press conference, calling on then Prime Minister Julia Gillard to support Cancer Council’s plan. Cancer Council backed it up with what became the “Empty Chairs” campaign - testimonials from people who’d lost loved ones to bowel cancer which ran in televised community service announcements to support full implementation of the screening program.

The Government duly injected $50 million into the program to add 60 and 70-year-olds. The bad news was, it was followed by a Government plan to complete the program by 2034 – despite Cancer Council calling for a 2020 completion date at the latest. Meanwhile, a decade since the original pilots had shown bowel cancer screening could work, in 2013 the country prepared for another election. Once again, bowel cancer failed to get the attention it deserved. Cancer Council needed a strategy.

CANCER COUNCIL RESEARCH CUTS THROUGH

We pulled together a research team to estimate the difference in lives saved between the Government’s 2034 plan and Cancer Council’s 2020 plan. The results were amazing – the Government’s plan would prevent 35,000 bowel cancer deaths by 2040, but Cancer Council’s plan would double that number – an incredible 70,000 lives saved over the same period.

The Abbott Opposition campaigned to support Cancer Council’s plan as the focus of its pre-election health policy and, after winning office, allocated $96 million in its first budget to deliver on the commitment. A bowel cancer screening program was set to be fully implemented at last.

INCREASING PARTICIPATION

A screening program is only as good as its level of participation and slow introduction and lack of promotion of the National Bowel Cancer Screening Program kept participation rates below 40%. Despite their life-saving potential, the free screening kits appearing in Australians’ mailboxes were being binned.

In 2017, Cancer Council Victoria ran a donor-funded, $1 million campaign to encourage people to do the test. The old “Empty Chairs” creative was dusted off and repurposed to help reduce costs. The seven week campaign exceeded expectations. Although it was only a short campaign with a modest budget, screening rates increased, potentially saving more than 300 people from developing bowel cancer and more than 180 dying.

Cancer Council took the findings to the Australian Government, calling for funds for a national campaign – a big ask, in a tight budget. Could our research again help cut through?

A new Cancer Council NSW study on the benefits of the program, published in the prestigious journal The Lancet, showed that if participation rates could reach and be sustained at 60%, 84,000 Australian lives would be saved by 2040. It also showed that investing in increased participation would be extremely cost-effective.

Cancer Council submitted a new recommendation for a national media campaign. Health Minister Greg Hunt agreed, and committed $10 million to the cause for a campaign over one year. In a government-first, he appointed Cancer Council to run the campaign, citing our research as a key driver.

At the campaign launch in January 2019, Minister Hunt stood with Professor St John, describing him as “the father of the program”. It closed the loop on an amazing 40-year journey of research, advocacy, community leadership and a small number of people who, with your support, are saving thousands of lives through bowel cancer screening.

Find out more about the impact of the 2019 national bowel cancer screening campaign.