Initial impact of Australia's National Bowel Cancer Screening Program

Ananda, Sumitra; McLaughlin, Steve; Chen, Fanglin; Hayes, Ian; Hunter, Andrew; Skinner, Iain; Steel, Malcolm; Jones, Ian T.; Hastie, Ian; Rieger, Nicholas; Shedda, Susan; Compston, Daniel; Gibbs, Peter

doi:10.5694/j.1326-5377.2009.tb02843.x

Cited by 41 publications

(41 citation statements)

References 14 publications

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“…20,28 Screening reduces the proportion of people with metastatic disease at diagnosis from 18% to 3%, and increases the proportion of those with local disease (Dukes Stage A) from 17% to over 40%. 29 A 10% conversion of cancers from advanced disease to local disease could be expected to save $27 million (900 cases at $30 000 per case) each year. Estimates from the Dutch modelling group, using US cost data, suggest that FOBT screening would become cost-saving (savings from treatment costs would exceed investment in screening) within 25–30 years, given changing treatment patterns and costs.…”

Section: Resultsmentioning

confidence: 99%

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Costs and cost‐effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia

Pignone

Flitcroft

Howard

et al. 2011

Medical Journal of Australia

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Objective To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50–74 years. Design and setting Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50–74 years. Main outcome measures Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. Results We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55 000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50–74 years would have gross costs of $150 million, reduce CRC mortality by 15%–25%, prevent 300–500 deaths from bowel cancer, and save 3600–6000 life-years annually, for an undiscounted cost per LYG of $25 000–$41 667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Conclusions Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

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Section: Resultsmentioning

confidence: 99%

“…Effect of stage-shifting on cost (net 10% cancers from Stage D to Stage A*)29 potential annual savings: $27 million …”

mentioning

confidence: 99%

Costs and cost‐effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia

Pignone

Flitcroft

Howard

et al. 2011

Medical Journal of Australia

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“…Lack of quality surveillance information compromises the assessment of actual population benefits and the impact on the incidence and mortality from CRC, particularly on population subgroups. Despite this, a recent analysis by Ananda et al [57] assessing the initial impact of the NBCSP from mid 2006 to mid-2008, reported its success in identifying CRC at an earlier stage. This study utilised linked data from hospitals across Australia to gather information on CRC cases reported by surgeons and found that 40% of cancers identified through the NBCSP (N = 40) were at Stage 1- the most treatable stage, compared to 14% among individuals who presented with symptoms to their doctor [57].…”

Section: Methods and Resultsmentioning

confidence: 99%

Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

2010

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BackgroundDespite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups.MethodsA search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions.ResultsThe NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening.ConclusionsOur findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.

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“…10 Stage distribution, localisation of cancers in the bowel and five-year relative survival after clinical diagnosis of a cancer were based on Australian literature. 14, 15 …”

Section: Methodsmentioning

confidence: 99%

Optimising the expansion of the National Bowel Cancer Screening Program

Cenin

John

Ledger

et al. 2014

Medical Journal of Australia

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Objective(s) To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening program (NBSCP) on the number of bowel cancer deaths prevented. Impact of the expansion scenarios on colonoscopy demand was also investigated. Design MISCAN-Colon, a well-established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50 year period, starting in 2006. The model parameters included participation rates for screening and follow up, cancerous and pre-cancerous lesion identification rates, bowel cancer incidence, mortality and the outcomes of the NBCSP. Five implementation scenarios, based on biennial screening using an immunochemical faecal occult blood test, were developed and modelled. A sensitivity analysis that increased screening participation to 60% was also conducted. Setting/ Participants Australian residents aged 50 to 74 years Main outcome measures Impact and comparison of five implementation scenarios on the number of bowel cancer deaths prevented and demand for colonoscopy. Results In its current state, MISCAN-Colon calculated that the NBCSP should prevent 35,169 bowel cancer deaths in the coming 40 years. Accelerating the expansion of the program to achieve biennial screening by 2020, more than 70,000 deaths would be prevented. If complete implementation of biennial screening resulted in a corresponding increase in participation to 60%, the number of deaths prevented increased across all scenarios. Conclusion(s) The findings strongly support the need for rapid implementation of the National Bowel Cancer Screening Program. Compared to the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths being prevented (approximately 35,000) in the coming 40 years.

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Initial impact of Australia's National Bowel Cancer Screening Program

Cited by 41 publications

References 14 publications

Costs and cost‐effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia

Costs and cost‐effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia

Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

Optimising the expansion of the National Bowel Cancer Screening Program

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