It's time - bowel cancer screening cannot wait for a fourth federal election

Cancer Council Australia calls on the next Australian Government to commit to a plan for the full implementation of the National Bowel Cancer Screening Program within the next parliamentary term, thereby filling the biggest gap in the national cancer response.

A fully implemented National Bowel Cancer Screening Program would prevent up to 30 Australian deaths each week.(1)  It is the best investment the next Australian Government can make in immediately reducing cancer morbidity and mortality – and it is cost-effective.

The absence of a full screening program is the most conspicuous deficiency in Australia’s national cancer control response, particularly in view of these facts:

• more than 13 years have passed since highest-level evidence showed bowel cancer screening’s capacity to save significant numbers of lives, as reported by the National Health and Medical Research Council;(2)
• nine years have passed since bowel cancer screening emerged as an election issue (3) and the successful screening pilot programs commenced;
• four years have passed since the piecemeal program commenced – and no implementation plan has been released;
• new data has added to evidence confirming the program’s cost-effectiveness;(4)
• the latest cost analyses show Australia’s annual bowel cancer treatment bill has hit $1 billion, inflated by delayed diagnoses in the absence of full screening;(5)
• more than half a million colonoscopies are performed in Australia each year at around $1300 each and an annual increase of 10%, a substantial number of them conducted inappropriately as a form of screening;(6)
•  recent data shows that even the current piecemeal program is picking up more than twice the number of early-stage cancers than those diagnosed through symptoms;(7)
• bowel cancer is the second most common cause of cancer death in Australia and will increase in incidence as our population ages;(8) and
• the effectiveness of screening programs for cervical and breast cancers, which have been fully implemented since 1991 and 1995 respectively, and were rolled out within five years of the Australian Health Ministers’ Conference committing to their implementation.(9)

New independent analysis indicates that the current program could be expanded from a one-off test for 50, 55 and 65-year-olds to a genuine national screening program targeting all Australians aged 50 to 74 for as little as $30 million in addition to the current annual allocation over 15 years.(10) 

On this basis, we estimate full program implementation could be achieved for around $135 million per annum at the outset, with offsets in reduced treatment costs and unnecessary colonoscopy accruing over time. The sooner the investment is made, the sooner the social and economic gains are returned.

For context, Australian governments spend $150 million per annum on screening for breast cancer;(11) the potential mortality benefit for full bowel cancer screening is at least as high as that achieved by Australia’s successful BreastScreen program.(12) 

Both the Labor and Coalition parties campaigned back in 2004 on commitments to phase in a bowel cancer screening program; Labor in the 2007 election added 50-year-olds to the interim program, but has not built on that commitment, despite a sweeping health reform agenda.

With the framework for a program already in place, and substantial investment occurring elsewhere in the health system, it is time for both sides of politics to build on their tentative commitments to the National Bowel Cancer Screening Program with a clear, costed plan for implementation in the next term of office.

Evidence is conclusive that screening all Australians aged 50 and over every two years with faecal occult blood testing would reduce bowel deaths by up to 30 each week.(13)

Bowel cancer causes more cancer deaths in Australia than any other form of the disease except lung cancer and is one of only three cancers for which population-based screening is recommended. The other two – cervical and breast cancer – have been subject to full, successful screening programs for 19 and 15 years respectively.

Australia should not have to wait any longer for the social and economic benefits of bowel cancer screening – and for an end to the unnecessary death toll caused by delays in program implementation.

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