Pilot program established in 3 sites in Australia - regional centre (Mackay, Qld), outer suburbs of a State capital (Melbourne) and inner suburbs of another State capital (Adelaide). The pilot targets people aged 55-74 years and is aimed to test the feasibility, acceptability and cost-effectiveness of a bowel cancer screening program.
Purpose of health policy or idea
Objective: to test the feasibility, acceptability and cost-effectiveness of a bowel cancer screening program
Characteristics: pilot program established in 3 sites in Australia; regional centre (Mackay, Qld), outer suburbs of a State capital (Melbourne) and inner suburbs of another State
capital (Adelaide). People aged 55-74 years (at Jan 1, 2003) and living in the Pilot sites will be invited to participate. A faecal occult blood test (FOBT) kit will be sent to participants by mail.
Participants collect the samples at home and send them to a pathology laboratory. Results will be sent to the participant, his/her nominated general practitioner (GP) and the Bowel Cancer Screening
Pilot Register. A positive test result (blood detected in a sample) will be followed up by the nominated GP to discover the cause of the bleeding. A negative test result will be followed by a
recommendation to repeat the FOBT in 2 years time. The laboratory will contact participants about an inconclusive or incomplete test and a new test kit will be sent. Some participants may require a
colonoscopy as part of their follow-up for a positive FOBT. In one pilot site (South Australia), virtual colonoscopy will be trialled.
Expected outcome: information about whether and how to implement a national bowel cancer screening program.
Incentives: the federal government has allocated A$7.2m over 4 years for the pilot program. This includes incentive payments to GPs for providing information regarding consultations
with participants to the Health Insurance Commission (who are maintaining the Register). Kits are free to participants, including postage etc.
to assess the feasibility, acceptability and cost-effectiveness of a bowel cancer screening program..
Type of incentives
"information" payments to GP, free kits to participants
Participants: People aged 55-74 years, GPs, Policy makers
|Degree of Innovation
|Degree of Controversy
|Structural or Systemic Impact
Political and economic background
The prevention and treatment of cancer is a National health priority area.
Purpose and process analysis
Current Process Stages
|Implemented in this survey?
Origins of health policy idea
Prevention and treatment of cancer is a national health priority
- The decision to implement a pilot screening program has been influenced by the development and evaluation of programs overseas, by the results from Australian studies which evaluated small-scale
screening efforts and by reports from the principal scientific bodies in Australia - the Australian Health Technology Assessment Committee (AHTAC, 1997) and the National Health and Medical Research
Council (NHMRC, 1999).
- There are a number of examples of Australia using pilot programs to trial the potential of a national program. The most relevant is the trial of breast cancer screening which occurred and was
evaluated in the late 1980s and early1990s and has since been implemented as a successful national program.
- The main actors include clinicians, researchers, consumer lobby groups and State and Federal policy makers.
Influences in policy making and legislation
The formation of the pilot register is made possible by amendments to the regulations covering the work of the Health Insurance Commission (HIC). However, as yet, no other legislation has been
required, although the agreement of the Commonwealth Parliament was required to access Medicare or Department of Veteran's Affairs enrolment records for names and addresses of people aged between
55-74 and living in the Pilot sites.
Adoption and implementation
- A lengthy process of meetings by the expert implementation group and task forces was facilitated by bureaucrats in the Commonwealth Department of Health and Ageing. The Pilot program has been
endorsed by the States and Territories through the Australian Health Ministers Advisory Council (AHMAC).
- There is little published information about any plans for the local or national evaluation of the Pilot program although the formation of the Register will facilitate the collection of data which
will inform some aspects of the evaluation. Previous multi-site pilot programs in Australia have involved both national and local evaluations with evaluators chosen by competitive tender. However,
previous trials have not involved the use of incentives for GPs and the evaluation of the extent to which this changes behaviour will be an important issue for evaluation.
- Local implementation committees, including representatives from Divisions of General Practice and other health professionals have been established in each site. Their role may differ from site to
- Further plans for adoption and implementation at a national level will depend on the outcomes of the pilot program.
Monitoring and evaluation
A Pilot program is inevitably the subject of an evaluation. There are currently no announced plans regarding the evaluation process (and this is likely to differ slightly from site to site).
The Register will:
- Invite potential participants to take part in the screening program
- Send reminder letters to people who have not sent their FOB tests to the laboratory within 6 weeks
- Follow-up people with a positive FOBT to ensure they receive appropriate medical care eg discuss result with their doctor, have colonoscopy or other diagnostic test
- Advise participants when it is time for their next FOBT
- Collect information about participation in the Pilot program including screening and detection history.
Dimensions of evaluation
- Until more details of the evaluation process and implementation are made available, it is not possible to say with certainty whether the Pilot program will achieve its objectives. However, given
previous Australian experience with mounting and evaluating a Pilot program for breast cancer screening, there are good reasons to expect that useful information on the feasibility, acceptability and
cost-effectiveness of a bowel cancer screening program will be forthcoming. In particular, the effects on GP behaviour of incentives will need to be carefully evaluated.
- Possible unexpected or undesirable effects may arise if a) the Pilot program raises expectations in the community that it will be ongoing but the evaluation does not produce results supporting
this or b) due to community and/or political pressure, an un-workable or un-economic Pilot program is expanded. The issues around a) are potentially resolved by the fact that screening for bowel
cancer is available to individuals through their GP, although the out-of-pocket costs to patients are likely to be higher than in any National program. The problems arising if b) is the case are
potentially more threatening to issues of quality, costs etc.
Sources of Information
See the website: http://www.cancerscreening.gov.au/bowel/bcaust/about_reg.htm
Author/s and/or contributors to this survey
Marion Haas, Jane Hall, Elizabeth Savage
Suggested citation for this online article
Marion Haas, Jane Hall, Elizabeth Savage. "Bowel Cancer Screening Pilot". Health Policy Monitor
, May 2003. Available at http://www.hpm.org/survey/au/a1/5