Australian expert backs bowel cancer screening as conflicting research published

While research led by the University of South Australia show effective screening is helping reduce the number of bowel cancer deaths - by up to 45 per cent; international researchers say routine testing for bowel cancer should not be recommended for everyone aged 50 - 79 but only those at high risk.

Most guidelines recommend screening for everyone from age 50, irrespective of their individual risk. At this age, the risk of developing bowel cancer over the next 15 years is typically 1-2 per cent, meaning that in a group of 100 people with the same risk factors, one or two will develop bowel cancer within the next 15 years.

The most common screening options are home faecal testing (FIT or FOBT) every year or every two years, sigmoidoscopy (examination of the lower colon) or colonoscopy (examination of the entire colon done at a clinic or hospital).

The South Australian study showed that while bowel or colorectal cancer kills almost 6000 people in Australia each year, the number would be much higher without pre-diagnostic colonoscopies.

Data from 12,906 bowel cancer patients indicated that the faecal test with a follow-up colonoscopy played a key role in catching the disease early, before symptoms appear.

Bowel cancer causes the second highest number of cancer deaths in Australia after lung cancer but 90 per cent can be cured if detected early, according to the Cancer Council.

Contradictory research by the University of Oslo involved an international panel of researchers, clinicians and patients which reviewed evidence including an individual's cumulative risk of bowel cancer over 15 years, together with the risk of harm (eg bowel perforations, unnecessary treatment) and quality of life (anxiety, burden of procedure) as well as a person's values preferences and life expectancy. It suggested no screening for healthy individuals aged 50 - 79 with a life expectancy of at least 15 years.

The report was published in the British Medical Journal.

However, these recommendations have not impressed one of Australia's leading colorectal surgeons.

Dr Graham Newstead a director at Bowel Cancer Australia said: "We have a good screening program with FIT every two years which helps us identify polyps earlier than we used to, when we were doing FIT every five years. It's still not perfect but it has gotten better.

"Let's not now be ridiculous by revisiting the guidelines to see if we can cut screening down further.

"By narrowing the screening program and excluding more people by looking at limited risk factors (as suggested by the study), the benefits of screening decrease exponentially," he said.

"Bowel Cancer Australia recommends participating in screening appropriate to your personal level of risk.

"Medical guidelines recommend people at average risk of bowel cancer screen using faecal immunochemical test (FIT) every two years from age 50.

"If you have one relative diagnosed with bowel cancer at 55 years or older, screening should be considered every two years from age 45.

The other thing that isn't considered is that more young people are getting bowel cancer.

"What the hell is causing that? Some suggest lifestyle issues but, until we know why so many people are getting cancers at a younger age, screening is essential."

A population-based screening program for bowel cancer is currently offered free in Australia to people turning 50, 54, 58, 60, 62, 64, 66, 68, 70, 72 or 74 years of age, with test kits sent by mail. For more information on eligibility visit www.bowelcancer.org.au

For people who would like to screen but are ineligible for the National Bowel Cancer Screening Program (NBCSP), Bowelscreen Australia is available for purchase in most pharmacies, online at https://www.bowelscreenaustralia.org/ or by calling the Bowel Cancer Australia Helpline 1800-555- 494.