Indigenous Bowel Screening – Health Professional Flipchart

Page last updated: 05 August 2020 (this page is generated automatically and reflects updates to other content within the website)

Indigenous Bowel Screening – Health Professional Flipchart (PDF 6.7 MB)




This flip chart has been produced by Menzies School of HealthResearch,to assist health workers to talk with Aboriginal and Torres Strait Islander people aboutbowel cancer and bowel cancer screening.

The flip chart has two sections:

Section One explains how bowel cancer develops, the signs or symptoms of bowel cancer, and the risk factors for bowel cancer.

Section Two describes the bowel screening test, why it is so important, and how to do the test.


The flip chart is designed to be used by health workers talking with Aboriginal and Torres Strait Islander clients about bowel screening. It can be used with small groups or with an individual/client.

Much of the text in this flip chart was developed through a widespread consultation and testing process to identify key messages about bowel screening that would work well for Aboriginal and Torres Strait Islander people. More than 250 people were involved in that process.

Health workers are encouraged to adapt the wording of these messages so they work for your community and clients.

The flip chart contains lots of information. You don’t need to use it all at once. You might want to use just a couple of pages or one section only. It’s designed to be used in whatever way suits you and your clients best.

Original Artwork Credit: Jordon Lovegrove NIBSP2018_006


This flip chart draws on earlier work and the wisdom and experience of many individuals across Australia who are committed to improving the participation of Aboriginal and Torres Strait Islander people in the National Bowel Cancer Screening Program.

The original version was produced in 2008 by the Queensland Bowel Cancer Screening Program, Queensland Health, and featured artwork ‘New World Order’ by Bianca Beetson and Kathleen Cameron. Julie Haysom produced the original hand rendered illustrations, from which the digital adaptations were generated.

The WA Bowel Cancer Screening Implementation Team, WA Health, refined it for use in WA, with artwork ‘Making Time’ by Valerie Ah Chee. The document, You’re lookin good on the outside But what about the inside? Screening for bowel cancer (2008), has been reproduced with permission from the WA Cancer and Palliative Care Network; the Government of Western Australia, Department of Health 2016.

SA Health produced a version with the assistance of health workers from the APY lands, Umoona Tjutagku Health Service, and the Aboriginal Health Council of SA (AHCSA), with additional artwork ‘Making Tracks’ by Karen Briggs and design work by Dreamtime Public Relations.

Illustration alterations and design were completed by Dreamtime Public Relations and Gilimbaa. The Menzies School of Health Research team included Gail Garvey, Jenny Brands, Anne-Marie Dewar, Brian Arley and Christine Long.

The artwork represents the National Indigenous Bowel Screening Project journey. The coloured meeting places are the Aboriginal and Torres Strait Islander communities and health services. The pathway that passes through the meeting circles represents the NIBSP tests being sent out to the community and then back to the processing centre for analysing. The processing centre is represented by the larger meeting place.

About the artist: JORDAN LOVEGROVE is a Ngarrindjeri young man who combines intimate knowledge of Aboriginal communities and illustration skills to develop outstanding Indigenous artwork which is applied to a range of print and online communications.


Bowel cancer:
  • is common among Aboriginal and Torres Strait Islander people;
  • can develop without any obvious signs; and
  • can be treated if found early.
There is a simple test you can do to find bowel changes early.

We’re going to spend some time talking about bowel cancer and bowel screening.


  • The bowel connects your stomach to your rectum where waste material (poo) is stored until passed out from the anus (bum).
  • The bowel has three main parts:
    • The small bowel – absorbs nutrients (goodness) from food.
    • The large bowel (colon) – absorbs water and salt.
    • The rectum – stores poo.
  • The bowel plays an important role in digesting food we eat.
  • Digestion is when food and drink are broken down into nutrients for our body to use for energy and to build and nourish our cells.


  • The bowel is made up of cells.
  • For our bowel to stay healthy, old cells are constantly replaced by new cells.
  • Sometimes things can go wrong during this process.
  • The cells become abnormal and gather in clumps. Some can turn into polyps. Some can turn into cancer.
  • Polyps are small growths on the lining of the bowel that look a bit like a cherry on a stalk.
  • Many polyps are harmless, but some grow into cancer.
  • Bowel cancer is most often found in the large bowel.
  • Tiny amounts of blood can leak from a polyp or a cancer and a bowel screening test can detect the blood.
  • If polyps are found early they can be removed and the risk of bowel cancer is reduced.


People are more likely to get bowel cancer if they are older than 50 years. This is the biggest risk.
Other risks include:
  • poor diet and being overweight;
  • smoking;
  • being inactive;
  • drinking a lot of alcohol;
  • having close family who have had bowel cancer (mother, father, brother, sister, child);
  • type 2 diabetes; and
  • bowel diseases like Crohn’s or Ulcerative Colitis.
Most people who get bowel cancer have no family history of the disease.


Most times there are no obvious early signs or symptoms for bowel cancer. Symptoms can include:
  • Blood on the toilet paper or in the toilet after a poo.
  • Feeling very tired for no reason (this is called anaemia).
  • Changes in your normal bowel habits e.g. looser poo or straining to do a poo.
  • Tummy pain without any reason.
  • Loss of weight for no reason.
That’s why it’s important to do a bowel screening test even if you have no symptoms.

If you have any of these symptoms, it does not necessarily mean that you have bowel cancer, but you should follow up with your doctor.



A bowel screening test involves taking two small samples of poo.

The screening test comes in a kit.

The National Bowel Cancer Screening Program mails out free kits to eligible people aged between 50 and 74. You may be offered a kit at your local health centre.

You can complete the test at home, or you might like to see if you can do the test at your health centre.

The samples are sent off for testing - you can post them, or your health centre might send them for you.

The samples will be tested in a National Bowel Cancer Screening Program contracted pathology laboratory which safely collects, transports and disposes of the samples.

The test results are sent back to you in a couple of weeks.


Bowel screening can pick up signs of changes to your bowel long before you might notice any symptoms. Bowel screening can save lives.
  1. Bowel screening is a test for people who do not have any signs of cancer.
  2. Often bowel cancer develops without any obvious signs.
  3. Polyps and very small bowel cancers can often bleed without you knowing.
  4. The bowel screening test can detect tiny amounts of blood in the poo.
  5. The test can pick up changes in the bowel long before you would notice any symptoms.
  6. Most bowel cancers can be successfully treated if found early.
  7. The bowel screening test is easy to do and doesn’t hurt.


In your kit you will find:
  • 2 x toilet liners
  • 2 x green top collection tubes
  • 1 x ziplock bag with two compartments
  • 1 x Reply Paid envelope



  1. On one of the tube labels, write your
    • full name
    • date of birth
    • date you take the sample
  2. Before collecting your sample, empty your bladder (do a wee) and flush the toilet.
  3. Put the toilet liner over the water in the toilet bowl. The writing should be facing up.
  4. If the toilet liner sinks, it’s still ok to take the sample.


  1. Do your poo onto the toilet liner.
  2. Open the collection tube by twisting the green cap.
  3. Scrape the tip of the stick over different areas of the surface of the poo. The sample only needs to be tiny – smaller than a grain of rice.
  4. Put the stick back into the collection tube and click the lid shut.
  5. Shake the tube up and down several times. Do not remove the stick again.
  6. Flush the toilet liner and poo down the toilet. Wash your hands.


  1. Place the tube into one compartment in the ziplock bag.
  2. Put the sample in the fridge. (Do not freeze).
  3. Repeat Steps 1 – 3 with the second collection tube when you do another poo (on the same day, the next day, or as soon as you can).


  1. Complete the Participant Details form.
  2. Write your name and address on the back of the Reply Paid envelope and sign the front.
  3. Put the Participant Details form and the two collection tubes (in the sealed ziplock bag) into the Reply Paid envelope and seal it.
  4. Take the envelope to a post office within 24 hours, or mail in the late afternoon (before 6pm) using an Australia Post mail box.
  5. The samples must remain cool, so do not leave them in a hot place such as a car.


Make sure you read all the steps before you do the test. Remember you need to take two samples from two different bowel motions. The second sample should be collected as soon as possible after the first.
  • Don’t stop your medication.
  • Eat what you normally do.
The test looks for blood in the poo, so don’t do the test if:
  • You have piles (haemorrhoids) which are bleeding. If this happens see your doctor and wait until your piles settle down before you do the test.
  • You have your menstrual period. Wait for three days after your period before doing the test.
  • There is blood in your urine or blood in the toilet bowl. If this happens, see your doctor.
  • You are having treatment for bowel problems.
  • You are booked for a colonoscopy in the next few weeks or if you have had a colonoscopy in the last two years.


  • About two weeks after your test has been sent off, you will get your test results back in the mail or from your health worker.
  • If your test is negative it means no blood was found. You don’t need to do anything, just do another test in two years.
  • Talk to your doctor if you have any symptoms before your next test. The test is very accurate but a negative result does not mean that you definitely don’t have bowel cancer or can never develop bowel cancer.
  • If your test is positive it means blood was found. You will need to see a doctor for a check up and maybe some more tests.
  • If the test is positive it does not necessarily mean you have cancer. But it is important to find out why there is blood in your poo.


During a colonoscopy a doctor inserts a tiny camera into the rectum to look for polyps or cancerous growths.

This is usually done in a hospital with a light sedation so you will need to have someone pick you up from the hospital.

The day before the colonoscopy you will need to have a special drink to help empty your bowel. You may need to take time off work or plan ahead if you need to travel for your colonoscopy.

If your test results come back positive (meaning there was apresenceofblood) your doctor will probably refer you for a colonoscopy. There is no cost for a colonoscopy as a public patient.

A colonoscopy is a procedure to look inside the bowel, usually done in a hospital under a light sedation. The doctor inserts a narrow flexible tube with a tiny camera attached into the rectum to look for polyps or cancerous growths.

As with all medical procedures, there are risks as well as benefits in having a colonoscopy. However, the benefits of finding cancer early far outweigh the potential risks. Talk to your doctor if you have any concerns.

If polyps or other growths are found, the doctor will usually remove them immediately and send them to a lab further tests.

After the procedure you will stay in the hospital for about two hours until the sedation wears off. You will need to have someone pick you up.

The day before the colonoscopy you will need to have a special drink to help empty your bowel. You will need to be near a toilet all day, so you may need to take time off work or plan ahead if you need to travel for your colonoscopy.


If you have any worries or concerns about the test or your results, you can speak to your health worker or doctor at your local clinic.

Talk to your doctor if:
  • you have a family history of bowel cancer; or
  • you think you might have signs of bowel cancer e.g. blood in the poo, changes in your poo like looser poo or straining to do a poo, tummy pain, weight loss, or feeling tired for no reason.


To reduce your risk of bowel cancer:
  • eat healthy foods e.g. eat more fruit and vegetables;
  • keep a healthy weight;
  • be physically active;
  • quit smoking;
  • avoid alcohol or cut down on the amount you drink; and
  • if you are aged 50 to 74, talk to your doctor or health worker about doing a bowel screening test.


Program Info Line: 1800 118 868
(calls from mobiles may be charged)