Bowel Screening in Australia: A coordinated approach

Initiatives to increase bowel cancer screening adherence in Australia

Introduction

Australia, where patients have the one of lowest chances of dying from their cancer in the world, has received international acclaim for it’s cancer infrastructure and preparedness.

However, Australia has a problem: bowel cancer rates are high, and uptake of screening - essential for picking up cancers at the earliest stages when cure is most likely - have recently been at just over 40% (compared to Wales at around 60%). ?

In part this may be because a full national bowel screening programme only fully rolled out in 2020 (compared to 2008 in Wales). In response to the problem of low uptake, Australia has embarked in recent years on a multi-pronged programme of research and transformation to address the problem.

‘No Australians dying from bowel cancer’ initiative

‘No Australians dying from bowel cancer’ is an initiative hosted within Health Translation South Australia, an accredited centre for translating research into healthcare practice, with workstreams from community prehabilitation to digital transformation.

The initiative started with research, firstly using modelling to demonstrate the immense number of lives and money which could be saved by an effective screening programme. This research (published before the national screening programme was implemented) was used for advocacy, and generated election commitments for investment in colonoscopy capacity.

The second phase aims to combine digital transformation (a computer assisted FIT+ referral system) and collaboration with lead endoscopists, to bring down waiting times for FIT+ colonoscopies.

Translational research in Victoria

Elsewhere, a multi-pronged research-informed improvement effort is in progress in Victoria, centred around collaborations between Melbourne University, and Cancer Council Victoria, with the principal aim of improving bowel screening.

GPs in Australia have historically been sceptical about FIT testing compared to colonoscopy. So in the first phase of the project, patient and clinician stakeholders were engaged to develop a risk-communication tool, showing why FIT represents the more appropriate risk/benefit profile for the moderately-at risk public.

Taking GP stakeholders into account, another research stream has been opened, to develop a GP consultation-based risk assessment and stratification tool for bowel screening. The tool supports primary care providers to identify which patients are at higher risk, for whom colonoscopy may be the best screening option. A decision-support tool is also being developed to help GPs recognise and appropriately refer symptoms of early bowel cancer.

The initiative extends into public engagement, for instance with a trial currently underway in 20 GP surgeries testing whether SMS-based encouragement and narrative from a GP can increase adherence to bowel screening.

Mass media campaigns have also been implemented and evaluated, showing impressive results in increasing kit return rate. This has been accompanied by more targeted awareness campaigns in harder to reach groups, such as individually tailored sessions for migrant communities, and co-designed awareness campaigns with indigenous communities.

Some reflections

Whilst the individual schemes here may not be hugely innovative, two features of the overall programme seem striking.

First is the programme’s measurable, specific, and ambitious targets. For example, one of the programme leads in Victoria states their aim to embark on a: “five-year programme to increase bowel cancer screening participation by at least 20 per cent to save 25,000 lives and $A400 million in health care costs for cancer treatment.”

Second, the programmes are notable for their coordinated and multifaceted approach to translational research. This research is conducted by bodies with strong links to healthcare, and with clear paths and commitments to expansion of interventions that are working.

Time will tell if Australia’s bowel cancer screening rates improve. But their approach is noteworthy, and we’ll be keeping an eye out for further lessons and insight for Wales.

If anything here sparks any thoughts are ideas, please feel free to reach out for a chat.