Report in English with a Dutch summary (KCE reports 45A)

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136 Screening for Colorectal Cancer: Appendices KCE reports vol.45 Individuals with an overall positive result will be referred to a local hospital where a pre-assessment will be undertaken by an NHS board-based nurse, and will be offered a colonoscopy examination, if appropriate. This arrangement may differ in some areas, for example in island NHS board areas. The National Screening Coordinator based within National Services Division (NSD) will have a responsibility to monitor and coordinate the screening program; however, the screening program will be integrated with the existing local colorectal services to ensure equity for all patients. As with all screening services, the national bowel screening program will require to quality assure the service that is provided and should be integral within existing quality assurance procedures and must meet the program s nationally set clinical standards. NHS Boards will be responsible for ensuring the quality and performance of care for the patients within their Board area who are referred for further investigation and treatment. Bowel Cancer UK has been contributing to preparatory work on the clinical standards being done by NHS Quality Improvement Scotland (NHS QIS) 567. The draft standards cover key elements of the bowel screening program such as the call-recall system, the screening process, the laboratory process and reporting, pre-colonoscopy and histopathology and the neoplasia yield. 7.9.2 Groups at increased or high risk Protocols for the surveillance of high risk groups are available from the SIGN guidance on Bowel Cancer. Moreover there s a high risk (HNPCC and FAP) genetics program in place nationwide 568 7.10 BELGIUM Today primary prevention of colorectal cancer in Belgium focuses on a healthy life style. In that scope several initiatives have been taken in order to increase awareness. The Stichting tegen Kanker and the Vlaamse Kankerliga for instance edited several brochures 569 on the prevention of colorectal cancer. More generally the Vlaams Instituut voor Gezondheidspreventie 570 offers information on healthy food issues. A national screening program for colorectal cancer screening has not yet been implemented. There are, however, emerging initiatives in the Flemish community to set up pilot projects in order to study the feasibility of colorectal screening in Belgium. Nowadays screening for colorectal cancer is disparately performed in several hospitals. The Saint-Joseph hospital (Liège) 571 for instance promotes virtual colonoscopy as a screening technique for people older than 50. In a consensus meeting on colorectal cancer screening, the Belgian gastroenterologists advocated the implementation of population screening for colorectal cancer in line with current national and European cancer screening programs. They recommended that mass screening should be made annually by FOBT(Hemoccult) test in all Belgian people 50 years old (except for increased risk categories). Colonoscopy is recommended as follow up in case of positive tests or in people at increased or high risk. 7.11 AUSTRALIA 7.11.1 Average risk groups
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 137 Efforts leading to a national screening program started in 1989 when professional bodies collaborated in drawing-up guidelines for screening and surveillance for colorectal cancer. An evidence-based consensus process undertaken in 1996 and 1997 recommended that the evidence supporting population screening justified consideration of screening as part of formal health policy but that issues around the detail of the screening process and its feasibility needed to be addressed 572. After a special allocation of funds from the government in 2002, the federal department agreed to plan a pilot screening program involving nearly 70,000 individuals aged 55 to 74 at three sites: parts of Melbourne and Adelaide and in Mackay, Queensland 573. Results of the pilot were formally analysed and reported to the government in 2005 574. Many of the outcomes of the pilot were positive, including: population participation at 45%, referral to colonoscopy after a positive test at 95%, waiting time for colonoscopy after positive test at median 30 days, caecal intubation rate at colonoscopy at 95%, incremental cost per life year saved of $22,000. Data collection processes, however, were not complete. As a consequence it was decided that in late 2006, a formal national screening program would start 575. Initially, screening utilising Fecal Occult Blood Tests (iFOBTs called ' Bayer Detect ) will be offered to Australians turning 55 or 65 years of age on a biennial basis, and those who participated in the successful pilot program that ran from November 2002 to June 2004. The test will be mailed directly to eligible participants by a national register, will be free of charge, will be performed at home and returned by mail. If the person returns a positive test, has symptoms or is identified to be at high risk, they will be directed to the primary care practitioner to organize appropriate action, usually colonoscopy through usual-care processes. There will be a single national registry 576 that tracks outcomes across the whole screening pathway and adherence to the pathway will be closely monitored. Mainstream health services will be used wherever feasible. An evaluation of the national bowel cancer screening program will be completed prior to the 2008 budget with the aim of extending bowel cancer screening, if successful on clinical grounds, to all Australians over 55 and Indigenous Australians over 45 years of age. In June 2006 the Australian Government minister for Health launched a media campaign It's Crunch Time 577 targeting employers and retail outlets. It's Crunch Time targets employers and community to help raise awareness of the early warning signs of bowel cancer. The aim of the initiative is to prevent bowel cancer through early detection and increased public education and awareness of the risk factors associated with the disease. 7.11.2 Groups at increased or high risk Registries provide a useful focal point for coordinating the management of high risk groups for colorectal cancer. It is difficult for any individual practitioner to offer comprehensive management that is family-based and provides continuity of support to successive generations, encompassing diagnosis, genetic counseling/testing, cancer screening and treatment. Therefore several Statebased familial cancer registers have been established in Australia. These facilitate the management of familial colorectal cancer by providing or supporting the maintenance of a meticulous, confidential and secure database on behalf of the present and future generations of a family, the liaison with relevant health care professionals, providing educational support and counseling, coordinating genetic counselling and testing etc.
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