Bowel cancer screening delays all about dollars but make no sense

Bowel cancer screening shouldn’t just be limited to Australians turning 50, 55 and 60. duvelNZ

In more than 30 years of treating cancer patients, I have seen some health policy decisions that defy common sense. But the most senseless of all is Treasury’s continued refusal to expand the National Bowel Cancer Screening Program (NBCSP).

There are thousands of Australians walking around right now, in apparent good health, with early-stage bowel cancer or precancerous polyps that will not be detected until symptoms appear. By then, it might be too late to save their lives.

The good news is there is an Australian screening program which could prevent up to 30 deaths each week from premature bowel cancer.

The bad news is the tests are only available to three age groups (people turning 50, 55 and 65) rather than to all Australians aged 50 and over, every two years, as recommended by the Government’s own National Health and Medical Research Council (NHMRC). So thousands are missing out.

When you look at the facts about bowel cancer, the case for extending the NBCSC is compelling:

  • It is one of the easiest cancers to treat if found early, yet it’s Australia’s second-biggest cancer killer (after lung cancer).

  • It can be one of the least expensive cancers to treat if detected early, yet it costs Australia’s health system more than any other cancer – around $1 billion per annum.

The federal government did the right thing by listing new drugs on the Pharmaceutical Benefits Schedule (PBS) to improve and extend the life of people with advanced bowel cancer. Yet it has penny-pinched on a modest investment in screening that would prevent thousands of people developing advanced bowel cancer in the first place.

Why the delay?

Since 1997, we have known that bowel cancer screening could save many lives.

In 2001, then opposition leader Kim Beazley and health minister Michael Wooldridge – to their credit – both took an interest in bowel cancer screening, with Beazley calling for a program to be funded and Wooldridge, under John Howard’s leadership, approving three pilot studies.

The results of the pilots were conclusive: Australians were comfortable enough with a home-based faecal occult blood test (FOBT). And a screening program using such tests would save lives.

Yet we waited another two years for the federal opposition (with its shadow health minister Julia Gillard) and the then government (with its health minister Tony Abbott) to commit to introducing the NBCSP as part of their 2004 election platforms.

Almost eight years later, we are still waiting for the program to be extended beyond three age groups, as recommended by the NHMRC.

Over this time, successive federal governments have used senseless arguments to defend the delays. One excuse was that the program needed to be phased in slowly while hospitals expanded their capacity to perform more colonoscopies. (People who have a positive FOBT result – traces of blood in their stool – are referred for a colonoscopy to look for cancer or precancerous polyps.)

Yet 500,000 colonoscopies are performed in Australia each year – many of them done as a high-cost substitute for screening, rather than for post-FOBT diagnosis, as recommended. So capacity is there; but it is being misdirected. And at more than 30 times the price of FOBT, colonoscopy is simply too expensive to be a population-based screening tool.

Then we were told that the NBCSP was being phased in incrementally, along similar lines to the BreastScreen Australia program. How wonderful if that were true! The Australian Health Ministers’ Conference agreed to introduce BreastScreen in 1991 and the program was fully implemented four years later. If the NBCSP received that kind of expeditious whole-of-government support, it would have been fully operational three years ago.

Today, no one denies that the delays in expanding the program are a simple matter of Treasury withholding funds in the interests of “fiscal restraint”. But this argument doesn’t hold – the cost-effectiveness of bowel cancer screening is strong.

Ultimately, the best explanation might be that too few people care about bowel cancer, despite its terrible toll on our community. Most of us could name several celebrity breast cancer patients. But where are the bowel cancer champions, when it is so much more common? This lack of visibility is perhaps the most disappointing thing of all.

As Treasury prepares the 2012-13 federal budget, we can only hope an appropriate value is placed on the lives of thousands of Australians with a hidden killer growing in them right now.

Failure to expand the program might save a few dollars in the short term, but it certainly wouldn’t make any sense.

For more information on the Cancer Council’s Get Behind 2012 campaign, click here