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Screening for Bowel Cancer (Colorectal Cancer)

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Why screen for bowel cancer?

Screening‘ refers to performing tests on people who have no symptoms, with the intention of diagnosing conditions which may otherwise have gone unnoticed. In the case of bowel cancer, screening tests are designed to detect cancer before it becomes large enough to produce symptoms. This allows treatment to start earlier, when the cancer is smaller, and increases the chances of being able to cure the cancer. Early detection and treatment of bowel cancer are important because bowel cancer is so common – one in every 21 Australians are expected to develop bowel cancer during their lifetime – and we have effective treatments available if cancer is detected early. However, screening tests are not designed for patients who already have bowel symptoms.

Some common symptoms of bowel cancer include:


Who should be screened for bowel cancer?

The Cancer Council of Australia recommends that any person over 50 years, without symptoms and without a strong family history of bowel cancer, should undergo a faecal occult blood test every two years. A positive result should be investigated with colonoscopy. Doing a faecal occult blood test (FOBT) every two years can reduce the risk of dying from bowel cancer by up to one third. Faecal occult blood testing is a simple test which detects the presence of blood in the stool (faeces). It can detect very small amounts of blood which are not visible to the eye. It is an effective screening test for bowel cancer because cancers or pre-cancerous growths often bleed very small amounts into the bowel. A positive faecal occult blood test does not mean that cancer is present. Further tests are usually needed to find the source of bleeding, for example with a colonoscopy.


What is the National Bowel Cancer Screening Program?

The National Bowel Cancer Screening Program is a program funded by the Australian government. It was introduced in August 2006 as a nationally coordinated way of improving the early detection of bowel cancers. The National Bowel Cancer Screening Program is currently inviting men and women turning 50, 55, 60, 65, 70 and 74 to screen for bowel cancer. Participants are sent a free, easy to use screening kit that can be completed at home.

In the 2014 Budget, the Australian Government announced a further $95.9 million over four years to introduce two-yearly screening for all Australians aged 50 to 74. Between 2015 and 2020, more age groups will be added to the screening program:

  • 2016 –72 and 64 year olds
  • 2017 – 68, 58 and 54 year olds


How does the National Bowel Cancer Screening Program work?

The program uses Medicare records to identify people who are turning 50, 55, 60, 65, 70 and 74. These people are sent an information pack and faecal occult blood screening test in the mail, inviting them to participate in the program. If you receive an information pack, it is not compulsory to participate in the program. However, if you do not wish to take part in the program, it is not possible to pass your invitation on to someone else. To participate in the program, individuals must collect two separate stool samples with the FOBT kit provided, and send the samples back to a central collection centre. The samples are analysed for the presence of blood. If the faecal occult blood test returns positive, further testing is needed to find the source of the bleeding. This is usually done with a colonoscopy. It is important to remember that a positive faecal occult blood test doesn’t always mean cancer. FOBTs can detect bleeding from many causes, including:

  • Non-cancerous problems such as haemorrhoids, or inflammatory conditions of the bowel
  • A pre-cancerous growth such as a polyp
  • Bowel cancer. Equally, because some polyps or cancers bleed only intermittently or not at all, a negative FOBT does not absolutely exclude cancer. This is why it is important to have regular FOBT screening every two years.


Can people who are not eligible under the National Bowel Cancer Screening Program still be screened?

Currently, only people who will turn 50, 55, 60, 65, 70 or 74 are eligible for free screening under the Australian government Program. However, people who are not eligible under the program can still be screened. In fact, the Cancer Council of Australia recommends that people over 50 years of age have regular faecal occult blood screening tests every two years. This can be coordinated through your general practitioner. It is possible to purchase faecal occult blood tests for use at home. There are two types available:

  • Immunochemical FOBTs, like the one used in the program, involve no dietary or medication restrictions. They cost approximately $30 each, and may have to be ordered direct from the supplier.
  • Chemical (guaiac) FOBTs work differently to immunochemical FOBTs. To use a guaiac FOBT, you must avoid eating red meat, certain fresh fruit and vegetables (eg. raw broccoli), taking vitamin C supplements, aspirin or anti-inflammatory drugs for three days prior to and during the sample collection period. Guaiac FOBTs are available from chemists and cost approximately $15 each.

If the FOBT result is positive, then further testing (usually a colonoscopy) is needed. For more information, speak to your doctor.


Related investigations

 

References

  1. Australian Government Department of Health and Ageing. ‘Screening – About the Program’ [online]. National Bowel Cancer Screening Program. 2007. Available at URL: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-1lp (last accessed 18/7/07)
  2. The Cancer Council Australia. National Cancer Prevention Policy 2004-2006: Bowel (colorectal) cancer. Available online: http://www.cancer.org.au/documents/NCPP_bowelcancer_links.pdf
  3. The Cancer Council Australia. Position Statement: Bowel Cancer Screening. Jan 2005. Available online: http://www.cancer.org.au/documents/Pos_State_Bowel_cancer_screening_JAN05.pdf
  4. National Bowel Cancer Screening Program. Consultation flipchart for use with patients. Available online: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bw-gp-flipchart/$File/gp-flipchart.pdf
  5. National Bowel Cancer Screening Program. Information for General Practitioners. Available online: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bw-gp-infochart/$File/gp-infochart.pdf
  6. NHMRC. Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer. 2005. Available online: http://www.nhmrc.gov.au/publications/synopses/cp106/_files/cp106.pdf
  7. NHMRC. Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer: A guide for general practitioners. Edition 2, August 2006. Available online: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bw-gp-crc-guide/$File/gp-crc-guide.pdf
  8. National Bowel Cancer Screening Program. About the program. (Cited 25 June 2015). Available online: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/about-the-program-1
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Dates

Posted On: 18 July, 2007
Modified On: 17 August, 2017

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