Optimising the expansion of the National Bowel Cancer Screening Program

Abstract

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.

Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer

“…We suggest that capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT-fecal DNA, CT colonography, and fl exible sigmoidoscopy (weak recommendation, low-quality evidence). 6 . We suggest against Septin9 for CRC screening (weak recommendation, low-quality evidence).…”

Assessment of a cancer screening program

“…Since 2008, the United States Preventive Services Task Force no longer recommends routine CRC screening in regularly screened individuals aged 75 years or older based on two CRC screening models suggesting that the benefit of continued screening in this age group is very small compared to the additional burden [16]. In 2014, the Australian government accelerated the expansion of their national CRC screening program when modeling indicated that this acceleration would increase the number of additional deaths prevented by the program by 35% [17]. Just recently in 2014, the Netherlands changed the cut-off used to define a positive FIT in their national CRC screening M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 12 program because following launch of the program many more individuals required colonoscopy for diagnostic follow-up than could be offered with the available colonoscopy capacity.…”

Compelling new data on the effectiveness of Australia's National Bowel Cancer Screening Program: A model for best practice?

“…Its findings are broadly consistent with recent modeling that, even on modest participation rates, the NBCSP would prevent 70 000 premature Australian deaths over the next 3-4 decades. 4 Another special feature of the study is the way linkage has been used to identify cancers in those with negative screening tests. Of the 1063 cases of cancer in the 2006-2008 participants, 887 (83.4%) were detected following a positive screening test.…”

“…[2][3][4] Having been involved in the NBCSP's development and promotion over many years (from a non-government perspective), we take this opportunity to comment on the study and to add context in relation to program developments since 2011. In our view, it provides evidence of benefit worthy of consideration across the Asia-Pacific region.…”