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

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.