Most Australians have always had an aversion to taking a simple and free at-home test that might save their lives.
Indeed, since the National Bowel Cancer Screening Program (NBCSP) began in August 2006, screening participation rates have not surpassed 44 per cent.
Men in particular have routinely dragged the chain.
Still, the program was slowly gaining ground. Until now.
Government figures show that participation in the screening program has declined for the first time in 10 years.
Meanwhile, bowel cancer is Australia’s second-biggest cancer killer.
What the figures show
According to the Australian Institute of Health and Welfare (AIHW), the national participation rate in the program had increased from 38.9 per cent of invited people aged 50–74 in 2014–2015 to 43.8 per cent in 2019–2020.
Then, suddenly, the participation rate dropped to 40.9 per cent in 2020–2021. “It is still unclear why this drop has occurred,” the AIHW said. Men (38.9 per cent) had a lower participation rate than women (42.8 per cent).
Participation rates were poor (31.9 per cent) in the younger age group 50-54 years. This is of concern as younger diagnoses are on the rise.
Men aged 50-54 had a screening participation rate of 29.8 per cent. Participation increased with age, and 53.1 per cent of Australians in the 70-74 age group undertook testing.
In more detail
According to the 2020–2021 preliminary data, almost 6.1 million people aged 50–74 were invited to participate in the NBCSP in that period. This means they received a letter, followed by a screening kit in the post.
Almost 2.5 million people returned a completed bowel screening test.
About 3.6 million people ignored the invitation. Some of those people would have eventually developed bowel cancer.
Presumably, having not been screened, their first sign of cancer was probably blood in the toilet. Which is late in the game. For some, too late.
Is COVID-19 to blame?
Dr Nick Musgrave is a Brisbane-based anatomical pathologist, and spokesman for Pathology Awareness Australia, a not-for-profit focused on community education.
He notes that the drop in participation coincided with the COVID-19 pandemic.
“Unfortunately, the COVID pandemic has resulted in a drop in participation at a time when we needed it to increase,” he said. “This has also been observed globally.”
“Concerns about the spread of the virus have overshadowed other primary healthcare concerns including cancer screening programs,” he said.
It was important to “understand how critical participation in the National Bowel Cancer Screening Program is”, Dr Musgrave said.
The dark reality is that most have not, and probably never will.
Not just COVID-19 to blame
COVID-19 may have played a hand in the most recent figures, but old-fashioned anxiety, denial and ickiness will continue to keep people from protecting themselves.
As Dr Musgrave stated in an email responding to questions:
“There are several perceived obstacles to wider participation in the bowel cancer screening program. A major one is what we call ‘the ick factor’.”
The test, which involves collecting two tiny samples using supplied tools, can be “confronting for many people, and the thought of sample collection makes them uncomfortable, as it’s obviously not something people are used to doing”, Dr Musgrave noted.
Also, he said, there was a perception of ‘this won’t happen to me’. This is particularly true of Australians in the 50-60 age group.
“The data shows participation in the 50-54 year age group is only 32 per cent, despite there being a growth in the incidence rate in this population in recent years,” he said.
Dr Musgrave said about one in 10 bowel cancers in Australia occur in people under 50 years of age.
Many people in this age bracket think they aren’t at risk, “but bowel cancer can strike at a younger age”.
With this in mind, doctors are keen “to make them aware of the importance of participation in the program”.
Not participating is plain silly
People with cancers diagnosed through the program have shown a 40 per cent lower risk of dying than people who had not been screened.
As Dr Musgrave observed: “When identified and diagnosed early, bowel cancer has a high survival rate, but late-stage bowel cancer diagnosis does not have the same positive outcomes.”
The five-year survival rate for Stage I bowel cancer is 99 per cent. And Stage II is 89 per cent.
For Stage IV bowel cancer (metastatic cancer) the five-year survival rate is just 14 per cent.
How successful is the screening?
The AIHW estimates that in 2021 about 7,365 people aged 50–74 were diagnosed with bowel cancer and 1908 people died from the disease.
In 2020, 85,693 Australians returned a positive screening test, giving a 7 per cent screening positivity rate.
Of those who received a positive screening test, 62 per cent reported a follow-up diagnostic assessment. This is usually a colonoscopy.
One in 95 follow-up diagnostic assessments resulted in a confirmed or suspected cancer diagnosis.
The median time from positive screening test result to diagnostic assessment was 49 days.
