Impact of COVID-19 on bowel-cancer screening
Some frequently asked questions about the bowel-cancer screening program.
Will the bowel screening program be paused during COVID-19 pandemic?
Not at this time. However, the strain on the health system as result of the COVID-19 pandemic is expected to result in unknown delays for follow-up medical appointments or procedures.
Will there be any changes to the program?
Participants will continue to receive screening kits and results through the mail. People with positive iFOBT results will still require follow-up, and their results letter will tell them to contact their GP to seek advice. When a GP or practice receives a positive iFOBT result for a participant, they may contact the participant to initiate a consult either via telehealth or face to face, and follow up patients who fail to attend. GPs should continue to refer patients to colonoscopy services for further investigation where appropriate.
The program recognises that the COVID-19 situation is impacting many aspects of the health care system in varying ways across Australia, so some participants may have delays before getting follow-up tests such as colonoscopy. Colonoscopy specialists will prioritise patients as appropriate. Cancer and clinical experts advise that a short pause in routine cancer screening of asymptomatic people is likely to be very low risk, given most cancers are slow growing.
Should we continue to refer patients with a positive iFOBT result to colonoscopy services?
GPs should continue to refer patients with a positive iFOBT result to colonoscopy services for further investigation where appropriate. While there may be a delay in colonoscopies for asymptomatic people during this period, GPs should continue to provide referrals to patients as usual where appropriate so that patients can be added to colonoscopy wait lists.
Due to the unprecedented pressure on the Australian health system, we expect there may be some disruptions and delays for follow-up appointments for participants who receive positive results. However, cancer and clinical experts advise that a short pause in routine cancer screening of asymptomatic people is likely to be very low risk, given most cancers are slow growing.
Given that participants fall into the 50 to 74 age bracket and may be at a higher risk for severe illness due to COVID-19, should they be discouraged from attending GP and pre-colonoscopy appointments in person?
If you have access to a telehealth service, you may wish to encourage participants to use this service if it is appropriate.
Will the National Cancer Screening Register contact centre continue to be operational?
Yes. The National Cancer Screening Register and contact centre will remain operational.
Role of GPs
GPs play a key role in ensuring that program participants progress through the screening pathway. GPs deliver clinically appropriate advice, services, treatment and care, and provide data on participants and their outcomes to the Program Register.
For your patients, you are asked to:
- encourage those who are sent a screening test and for whom the test is clinically relevant, to participate.
- assess those with a positive result and refer them for further examination as clinically indicated, for example a colonoscopy. The National Health and Medical Research Council (NHMRC) approved Guidelines state that participants with positive iFOBT results should have follow-up investigation unless there was a clear breach in protocol when samples were collected (e.g. menstrual blood loss close to the time of sample collection) and that colonoscopy should be performed as promptly as possible after a positive iFOBT to minimise the risk of psychological harm, although there is no evidence that prognosis is worsened within 120 days if cancer is present.
- indicate whether a patient referred for colonoscopy is a Program participant to assist with reporting to the Program Register. Program stickers are available by calling the Information Line on 1800 118 868.
- notify the Program Register of referral/non referral for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the Program’s GP Assessment Form by fax, post or electronically. Provision of information will attract a payment.
- inform patients at average risk, or slightly above, that the NHMRC approved Guidelines recommend screening every two years, starting at age 50 years and continuing to age 74 years
- manage patients identified as being at increased risk of bowel cancer in accordance with the NHMRC approved Guidelines.
- manage patients (of any age) with symptoms in accordance with the NHMRC approved Guidelines, in recognition that bowel cancer can occur at any age.
The Program does not seek to impose any additional duty of care upon medical professionals. However, GPs should be mindful that the actions they take are in accordance with existing professional standards. See RACGP Standards for General Practice - Criterion GP2.2 – Follow up systems for further information. Some approaches that a GP or practice may take if they receive a positive iFOBT result for a Program participant are to contact the participant to initiate a GP appointment, and if required follow up patients who fail to attend GP or colonoscopy appointments. Alternatively, if a GP or practice receives a result for a participant who is not known to them, or who they are unable to accept as a patient, they should advise the Program Register on 1800 118 868. The Register will remove the GP’s contact details from the Register and contact the participant to advise them to make an appointment with another GP.
Role of practice nurses
Practice nurses have an important role to play in encouraging and supporting patients to participate in the Program. Nurses can act as connectors between patients and their GP as both an advocate and interpreter.
To encourage your patients to screen, you can:
- Promote the Program in your practice;
- Undertake a screening audit of practice records;
- Talk to your patients aged 49 to 74 about screening;
- Send a letter to 49 year olds to encourage participation;
- Find out when patients will receive a kit, and if appropriate encourage participation;
- Demonstrate to patients how to use a bowel screening test kit;
- Assist with completing forms for Program participants; and
- Refer patients (of any age) with symptoms, bowel disease or family history to a GP in recognition that bowel cancer can occur at any age.
The Australian Primary Healthcare Nurses Association, in partnership with the Cancer Council WA and funded by the Australian Government Department of Health, has developed resources and training on the Program for nurses working in general practice.
How can general practices support participation?Research consistently demonstrates that a recommendation from a primary care provider to screen for bowel cancer is an important motivator for participation. General practices can encourage their patients to participate by:
- Displaying brochures, flyers and posters – Order Program Resources
- Talking to patients aged 50-74 years about bowel cancer screening - Download Clinical Resources
or check when an individual will get a kit
- Demonstrating how to use a kit. Demonstration kits can be ordered by emailing NBCSP@health.gov.au
- Sending a letter to 49 year old patients to encourage participation - Download a template letter
- Knowing the Program – this series of short videos provides a simplified approach to the NBCSP covering the following topics: What is screening, Classification of risk, Referral to colonoscopy and Case studies. For practice nurses this Webinar is a one-hour online seminar on bowel cancer, screening and how nurses working in general practice can approach bowel screening with patients
- Download the Promoting the NBCSP in General Practice fact sheet for tips on how to support the Program.
Send a letter or SMS to your patients
There is strong evidence that a letter signed by a person’s GP endorsing FOBT is an effective method to increase participation in bowel cancer screening.
GPs can use this template letter to recommend screening to patients outside of regular consultations. Currently, 50 year olds have the lowest participation rate in the Program. It is recommended that general practices send the letter to 49 year old patients to encourage them to do the test when they receive it in the mail around their 50th birthday.
You can delete the icons from the letter before you send it if you prefer.
Alternatively you may wish to send the following text message (SMS) to your 49 year old patients.
Around your 50th birthday you will be sent a free bowel cancer screening kit.
Please do this test - screening saves lives.
Or you could encourage your 50-74 year old patients to participate by sending the following SMS.
If you’re aged 50-74 and eligible you will be sent a free bowel cancer screening kit.
Please do this test - screening saves lives.
Check when your kit will arrive at www.cancerscreening.gov.au/bowel
Health service providers have obligations under the Privacy Act 1988 and relevant State and Territory privacy laws when handling personal information. The template letter has been drafted to comply with relevant privacy obligations. If you alter the letter before you send it to your patients, you should consider whether it still meets your privacy obligations. If you have any queries about your privacy obligations please email the Office of the Australian Information Commissioner or call 1300 363 992.
Program evidence base
The National Health and Medical Research Council (NHMRC) Guidelines recommend FOBT screening every two years, starting at age 50 years and continuing to age 74 years, for people who are at average risk, or slightly above, for bowel cancer (about 95-98 per cent of the population).
- In line with this, the Program is expanding in stages so that by 2020 all eligible Australians aged 50-74 years will be invited to participate every two years.
- The direct mail model used by the Program is the most common model internationally and the most effective recruitment method for a population based bowel screening program.
- A 2014 study by the Australian Institute of Health and Welfare found that:
- Program invitees had 15% less risk of dying from bowel cancer, and were more likely to have less-advanced bowel cancers when diagnosed, than non-invitees.
- the immunochemical FOBT used in the Program has a high degree of accuracy (estimated 83% sensitivity and 93% specificity).
- A July 2015 Healthpact report found that the immunochemical FOBT, as is used in the Program, is the best performing screening test for use in population screening.
- In 2014, 7% of participants (34, 378 people) returned a positive screening test, and of these 73% (25,242 people) had a diagnostic assessment recorded by the end of 2015. Of assessments occurring in 2014, there were:
- 181 (0.7%) confirmed cancers;
- 638 (2.4%) suspected cancers; and
- 3655 (14%) adenomas detected.
For more data on the Program see the 2018 Program Monitoring Report