|Bowel Cancer Screening Pilot|
|Implemented in this survey?|
We previously reported on the establishment of a bowel cancer screening pilot program. Since then the Federal Government has announced that it will phase in a national program with the ultimate aim that by 2008 every Australian will be screened for bowel cancer every two years. The final report of the Bowel Cancer Screening Pilot Program was published in October 2005. It showed favourable outcomes in terms of each of the key research objectives: feasibility, acceptability and cost-effectiveness.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The results of the pilot show that a national bowel cancer screening program is feasible, acceptable and cost-effective. There will be a significant challenge in raising participation
rates and delivering the program in the immediate future. This is why it is sensible for the program to be phased in over a number of years. Another key challenge, and one that
has been given some media attention- is the issue around ensuring equitable access to high quality colonoscopy.
It is highly likely that there will be a considerable increase in the demand for colonoscopy services following the implementation of a national bowel cancer screening program. Currently, there is only limited capacity in the public sector for further colonoscopy services - and the cost of private colonoscopy can be high, especially for 55% of the population who are not privately insured.
|Implemented in this survey?|
The final report of the Bowel Cancer Screening Pilot Program was published in October 2005. It showed favourable outcomes in terms of each of the key research objectives: feasibility,
acceptability and cost-effectiveness (a summary of the results will be reported later in this survey). During the 2004 election campaign (and 12 months prior to the publication of the pilot
program report), the federal government announced that it would invest AUD 25.5 million over four years on a national bowel cancer screening program. This election announcement became, in
effect, the policy paper.
The government's announcement was publicly welcomed by the Australian Cancer Council and the Clinical Oncological Society of Australia. The Cancer Council of Australia is a national non-government cancer control organisation. The Council acts nationally to advise government and other bodies on appropriate practice and policies for the prevention, detection and treatment of cancer and is an advocate for the rights of cancer patients to best treatment and supportive care.
|Prime minister and cabinet||very supportive||strongly opposed|
|Cancer council of Australia||very supportive||strongly opposed|
Thus far this policy has required little legislative change, and therefore the input from the legislature has been limited. The implementation of a national bowel screening program was announced one year prior to the publication of the final pilot evaluation report. Therefore it is difficult to make definitive conclusions about whether the evaluation had any significant influences on the design of the policy - noting that large aspects of the policy still need to be developed. There are however two main policy differences between the Government's election announcement and the final evaluation report. These were:
|Prime minister and cabinet||very strong||none|
|Cancer council of Australia||very strong||none|
The Government committed itself to a national roll-out of a bowel cancer screening program in 2004 but many aspects of the implementation phase are yet to be fully developed. It has
allocated AUD 43.4 million over three years for the program The program will be phased in over three years, commencing in mid 2006. Initially screening utilising Faecal Occult Blood Tests
(FOBTs) will be offered to Australians turning 55 or 65 years of age. People participating in the program will be invited to complete a simple test in the privacy of their own home and mail it
in for analysis. Participants with a positive result will be referred by their GP for further tests, usually a colonoscopy.
The program has received overall support. General practitioners involved in the pilot study have been supportive, as have important advocacy groups such as the Cancer Council of Australia. However, the pilot study achieved a participation rate of 45.4%. This results was lower amongst certain population groups, in particular people with an Aboriginal and Torres Strait Islander background.
Issues around participation and follow-up have been identified as key issue for the program.
The Australian Department of Health and Ageing reports that "an evaluation of the national bowel cancer screening program will be completed prior to the 2008 Budget with the aim of extending bowel
cancer screening, if successful on clinical grounds, to all Australians over 55 and Indigenous Australians over 45 years of age".
It is interesting to note that the decision to expand the program will be based solely on clinical grounds - excluding economic considerations.
The final report of the pilot bowel cancer screening program showed:
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
This policy will have a significant impact on the early detection of bowel cancer; one of Australia's biggest cancer killers. The roll out of a national program will ensure greater equity of access but the key challenge will be to ensure higher participation rates than those achieved in the pilot programs, and ensuring that down-stream issues such as the availability of high quality colonoscopy do not impose high barriers of access in the program's follow-up procedures.
For information about the National Bowel Cancer screening program visit:
For the final evaluation report visit:
For the Government's election announcement visit:
For the Cancer Council of Australia and Clinical Oncological Society of Australia media notice visit:
|Bowel Cancer Screening Pilot|
Process Stages: Evaluation, Idea, Pilot
Kees van Gool