Delivering a Healthy WA

WA Cancer and Palliative Care Network – Improving the Patient Experience

National Bowel Cancer Screening Program

Phase 1

Phase 2

Phase 2 continuation

Faecal Occult Blood Test

Participant Follow-up

NBCSP resources

More information and useful links

Phase 1 (27 January 2007 30 June 2008)

As part of its Strengthening Cancer Care initiative in the 2005-06 Federal budget, the Australian Government announced it would phase in a National Bowel Cancer Screening Program (NBCSP). Phase 1 of the NBCSP commenced in Australia in August 2006, with WA commencing in January 2007 and concluded 30 June 2008.

Phase 1 targeted those Australians turning 55 and 65 years of age between 01 May 2006 and 30 June 2008, as identified by Medicare Australia or the Department of Veterans' Affairs. Approximately 100,000 Western Australians were invited to participate during Phase 1, receiving a free Faecal Occult Blood Test (FOBT) kit in the post. The invitation process in WA was staggered, with roll out occurring geographically, until the entire State was involved.

In addition, the WA Government committed to support the introduction of the NBCSP in our state. The WA Department of Health established the Bowel Cancer Screening Implementation Team (Bowel Team), within the WA Cancer and Palliative Care Network, to collaborate with the Australian Government to roll the NBCSP out across WA. The Bowel Team also works in partnership with key stakeholders across the State, including Cancer Council WA and the WA General Practice Network, to support health professionals and community education relating to the NBCSP.

Phase 2 (01 July 2008 – 30 June 2011)

In May 2008, the Australian Government committed to expand the NBCSP to screen all 50, 55 and 65-year-olds for bowel cancer. The target cohort has been increased to include Australians turning 50 (from 01 January 2008 to 30 December 2010), in addition to those turning 55 or 65 (from 01 July 2008 to 30 December 2010).

Phase 2 of the NBCSP began 01 July 2008 and ran until 30 June 2011. Over 212,000 Western Australians were invited during Phase 2.

Program suspension and remediation

The NBCSP was suspended in May 2009 after a drop in the positivity rate was detected coinciding with a change to the FOBT kit. Investigations revealed the serum in the FOBT used to preserve blood in collected samples was not stable at high temperatures. Consequently, use of that FOBT kit was discontinued in the NBCSP from this time.

Participants who received a positive result with the unreliable FOBT were advised their result was valid, and they should continue to follow-up investigation by colonoscopy. Participants who had received a negative or inconclusive test result were advised of the uncertainty of their result, and that a new kit would be provided as soon as possible. They were also advised to see their doctor if they experienced any symptoms associated with bowel cancer. Those people who had been invited whilst the unreliable FOBT was in use, but had not yet completed the test kit were advised to discard the kit, and a new kit would be provided as soon as possible. They were also advised to see their doctor if they experienced any symptoms associated with bowel cancer.

The NBCSP restarted in November 2009 using the New HemTube (B) FOBT kit that is approved for use by the Therapeutic Goods Administration (TGA). Priority was given to retesting those people who had received a negative or inconclusive result with the unreliable FOBT, followed by those people who had previously been invited whilst the unreliable FOBT was in use but had been advised not to complete the kit. Mail out of replacement kits was finalised by 2010.

More information on the suspension and remediation process can be found on the NBCSP website: www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/program-suspension (external site)

Phase 2 continuation (01 July 2011 – 31 December 2014)

The Australian Government is continuing Phase 2, inviting Australians turning 50, 55 or 65 years of age between January 2011 and December 2014, who hold a Medicare card or DVA gold card.

More information on the current phase of the NBCSP is available on the NBCSP website: www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-about (external site)

Faecal Occult Blood Test

FOBTs detect small amounts of blood in faeces, which may indicate the presence of an abnormal growth in the bowel. FOBTs do not detect cancer, but are useful indicators for further investigations, such as colonoscopy.

The National Health and Medical Research Council’s Guidelines for the prevention, early detection and management of colorectal cancer 2005 (www.nhmrc.gov.au/guidelines/publications/cp62 (external site)) state “a person with of positive FOBT has a 30% - 45% chance of having an adenoma and a 3 -10% chance of colorectal cancer.”

Invitees in the NBCSP are mailed a free FOBT kit from the Australian Government. Participants complete the test at home and send it to the contracted laboratory for processing.
Participants with positive FOBTs are alerted, in writing, by the testing laboratory and advised to consult their GP, who will discuss the most appropriate option for investigation, usually colonoscopy.

Colonoscopic assessment will help determine whether there is any abnormality present, its type and significance. Biopsies of tissue from the bowel may be taken at colonoscopy to confirm findings. If cancer is found, patients will be referred to a surgeon to discuss the most suitable options for treatment.

More information about colonoscopy can be found on the NBCSP website www.cancerscreening.gov.au (external site).

Participant Follow-up

Since June 2009, the Bowel Team has provided reminder calls to NBCSP participants in WA who do not appear to have attended their follow-up, either with their GP or colonoscopist. The NBCSP Register may also write to participants to remind them to attend for their follow-up as part of the safety-net function for the NBCSP.

Participant Follow-up Officers (PFOs) only contact participants with a positive FOBT to confirm with them if they have seen their doctor for follow-up. The information provided will then be forwarded to the NBCSP Register, operated by Medicare Australia to ensure screening records are current.

The information accessed by PFOs on the NBCSP Register is strictly confidential and protected by legislation. The PFO can access information for the sole purpose of assisting with follow-up duties. Only the participant (and not other family members) will be contacted by the PFO to ensure privacy is maintained.

More information on how your screening information is used and protected is available on the NBCSP website:
www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/program-register (external site)

NBCSP resources

Information about bowel cancer and the NBCSP can be found on the NBCSP website www.cancerscreening.gov.au (external site). Information is available in English and a variety of other languages.

Promotional Poster

WA has developed a promotional poster, ‘Because you can’t see what’s going on inside you…’, for the NBCSP to be used in GP surgeries, colonoscopy units and health clinics to promote awareness of the NBCSP and to remind participants to identify that they have tested as part of the program to their clinician.

Promotional Brochure

Bowel cancer among men.. what you should know

Aboriginal and Torres Strait Islander resources

The Bowel Team has also developed some resources to improve awareness of bowel cancer and to encourage participation in the NBCSP among Aboriginal and Torres Strait Islander community members.

General Practitioner resources

A notification flyer for GPs has been developed to provide referral pathway information.

On-line learning modules are available for GPs relating to the NBCSP through the RACGP website: www.racgp.org.au/gplearning (external site)

More information and useful links