Bowel cancer

Early Detection Policy

UPDATE: From 1st July 2024, the Australian Government is lowering the eligible screening age for the National Bowel Cancer Screening Program. People aged 50-74 will still be sent a free home test kit by the Australian Government every two years, but now people aged 45-49 can also request a free screening kit to be mailed to them.

Bowel (colorectal) cancer causes the second highest number of cancer deaths in Australia (after lung cancer) yet can usually be treated successfully if detected early.

Bowel cancers typically begin as precancerous polyps, called adenomas, which can be detected and removed before becoming cancers. The cancer tumours themselves can also be removed with relative efficiency if detected before they spread beyond the bowel.

In 1997, the Australian Government published an analysis of the data on bowel cancer screening that clearly showed the benefits in mortality reduction on a population basis. The evidence shows these are highest in people aged 50 and over, screened every two years; evidence does not support mass screening of people aged below 50.

In 2002, the government conducted pilot studies that supported the clinical and cost-effectiveness of biennial population screening for bowel cancer in Australia using the faecal occult blood test (FOBT).

The Australian Government's National Bowel Cancer Screening Program, introduced in 2006, now provides a free FOBT kit and pathology to all Australians aged 50 to 74. Cancer Council urges all eligible Australians to participate.

Detailed analysis of the evidence on bowel cancer screening and recommendations on the roll-out of Australia's National Bowel Cancer Screening Program is available on these pages.

Cancer Council Australia first published a chapter of its National Cancer Prevention Policy calling for the introduction of a bowel cancer screening program in Australia in 2001. The chapter has since undergone four comprehensive reviews, with evidence-based recommendations to advance bowel cancer screening in Australia.

This 2018 update draws on the systematic review which informed the NHMRC-approved Clinical practice guidelines for the prevention, early detection and management of colorectal cancer (third edition), published in October 2017.

It has been reviewed internally by the Screening and Immunisation Committee of Cancer Council Australia’s principal Public Health Committee and externally by: Dr Hooi Ee (Gastroenterologist, Sir Charles Gairdner Hospital) and Prof Mark Jenkins (Director of the Centre for Epidemiology & Biostatistics, University of Melbourne). It has been approved by Cancer Council’s principal Public Health Committee in October 2018.

Contact: Amanda McAtamney

Key policy priorities in summary

Government investment to increase participation in the National Bowel Cancer Screening Program (NBCSP), through:
- Adequately funded communications strategy to increase awareness and drive behaviour change at a population level
- Adequately funded primary care engagement strategy to leverage the role of GPs
Promotion of clinical practice guidelines to health professionals to drive best practice in prevention and detection of bowel cancer
Explore opportunities for policy reform to improve the efficiencies in the health system

Bowel cancer, also known as colorectal or large bowel cancer, is a major health problem in Australia. In 2015, 15,604 new cases of bowel cancer were reported – 8573 in men and 7031 in women; in 2016, there were 5375 deaths in Australia from bowel cancer: 2936 in men and 2439 in women.^[1] Bowel cancer is the second most common cause of death from cancer^[2] and second greatest cause of cancer burden in Australians.^[3] Bowel cancer survival is lower for Indigenous than non-Indigenous Australians.^[4]

Bowel cancer is the most economically expensive cancer to treat in Australia, with the total costs estimated at $1 billion in 2013; the majority of expenditure is for hospital treatment.^[5]

Lifestyle can have a significant impact on bowel cancer risk. An Australian analysis estimated that 36% of bowel cancers diagnosed in 2010 were attributable to dietary factors^[6] and 6.5% were attributable to insufficient physical activity.^[7] Smoking was attributable for 7% (females) and 5.9% (males) of cases in Australia in 2010. Alcohol consumption was associated with 12.9% of cases in men and 4.2% in women.^[6] In total, almost half (49.8%) of all bowel cancers cases diagnosed in Australia in 2010 could be associated with a preventable risk factor.

Comprehensive information on reducing cancer risk (including bowel cancer) through lifestyle, behaviour and related public policy is available in the chapters on Tobacco control, Alcohol and cancer, and Overweight and obesity, physical activity and nutrition.

Bowel cancer is one of only three cancer types for which population-based screening is recommended as a way to reduce mortality and morbidity by finding early-stage cancers and/or precancer lesions in people without symptoms (along with breast cancer and cervical cancer). Clinical recommendations state that bowel cancer screening using immunochemical faecal occult blood test (iFOBT) should be offered once every two years for those aged between 50 and 74 years.^[8][9]

In 2006, the Australian Government introduced the National Bowel Cancer Screening Program (NBCSP) offering a one-off iFOBT to people turning 55 and 65. The program has since been rolled out in phases to include other age cohorts in the program. Funding to implement biennial screening of all Australians aged 50-74 by December 2019, in line with clinical recommendations^[8][9], was announced in the 2014-15 federal budget.^[10]

This chapter describes the impact of bowel cancer in Australia, the policy context of bowel cancer screening in Australia is outlined in relation to the NBCSP and Cancer Council's policy priorities are summarised. Lastly, it provides information on bowel cancer prevention and screening.

References

Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Available from: http://www.aihw.gov.au/acim-books/.
Australian Institute of Health and Welfare. Cancer in Australia 2017. Canberra: AIHW; 2017 Feb. Report No.: Cancer Series No. 101, Cat. no. CAN 100. Available from: https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true.
Australian Institute of Health and Welfare. Burden of cancer in Australia: Australian Burden of Disease Study 2011. Canberra: AIHW; 2017 Jun. Report No.: Australian Burden of Disease Study series no. 12. Cat. no. BOD 13. Available from: https://www.aihw.gov.au/getmedia/a1aec7bd-ddb7-416f-9a7e-f2133cd5d4cb/20965.pdf.aspx?inline=true.
Condon JR, Barnes T, Cunningham J, Armstrong BK. Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Med J Aust 2004 May 17;180(10):504-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15139826.
Ananda S, Kosmider S, Tran B, Field K, Jones I, Skinner I, et al. The rapidly escalating cost of treating colorectal cancer in Australia. Asia Pac J Clin Oncol 2016 Mar;12(1):33-40 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25866889.
Whiteman DC, Webb PM, Green AC, Neale RE, Fritschi L, Bain CJ, et al. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust N Z J Public Health 2015 Oct;39(5):477-84 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26437735.
Olsen CM, Wilson LF, Nagle CM, Kendall BJ, Bain CJ, Pandeya N, et al. Cancers in Australia in 2010 attributable to insufficient physical activity. Aust N Z J Public Health 2015 Oct;39(5):458-63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26437732.
Cancer Council Australia Colorectal Cancer Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. [homepage on the internet] Sydney: Cancer Council Australia; 2017 Oct Available from: https://www.cancer.org.au/clinical-guidelines/bowel-cancer/colorectal-cancer.
Australian Health Technology Advisory Committee. Colorectal cancer screening. Canberra: Commonwealth Department of Health and Family Services; 1997.
Federal Coalition. The Coalition’s Policy to Support Australia’s Health System. Australia: Federal Liberal and National Party Coalition; 2013 Aug Available from: http://lpaweb-static.s3.amazonaws.com/13-08-22%20The%20Coalition%E2%80%99s%20Policy%20to%20Support%20Australia%E2%80%99s%20Health%20System.pdf.