This year 17,000 Australians will be diagnosed with bowel cancer and every week 80 people will die from this disease. Meanwhile Australia’s National Bowel Cancer Screening Program (NBCSP) has run out of funding and ground to a halt.
Australian studies clearly highlight how a fully implemented, population-based bowel screening program could halve the number of deaths through early detection, and in many cases prevent the onset of cancer by detecting pre-cancerous growths.
It generally takes five to ten years for bowel cancer to develop from an identifiable pre-cancerous polyp. It is this five to ten year window that characterises bowel cancer as an ideal candidate for a screening program, with huge opportunities for reducing bowel cancer mortality rates.
The Cancer Council estimates that a national screening program, testing over 50s every two years with a faecal occult blood test (FOBT) would cost about $140 million per year.
But preventing the onset of cancer will save money as well as lives. Removing a precancerous polyp costs around $1,600, whereas treatment at a public hospital for bowel cancer can cost more than $70,000.
The costs of treating bowel cancer have risen more than fourfold over the past decade and are set to rise further as the cost of new biologic drugs – the very medicines that Health Minister Nicola Roxon now says cannot be listed on the Pharmaceutical Benefits Scheme unless cost offsets are found – averages $50,000 per case for advanced cancers.
Even with the low participation rate seen in the pilot studies, the estimated cost per additional life-year saved is $20,000.
In comparison, the cost effectiveness figures for the BreastScreen Australia and the National Cervical Screening Programs are around $9,500 to $16,000, and $44,500 per life-year saved respectively.
Ironically it was the Labor Party in opposition which pushed the Howard Government into introducing the NBCSP in 2005, and it was a 2007 Labor election policy that promised a fully implemented screening program as part of a health-care reform plan focused on intervening early, preventing serious illnesses, and reducing pressure on hospitals.
Last year the Health Minister acknowledged in Parliament that “the government has received advice that the absolute rolled gold clinical standard would be to commence screening at 50 and to do that every two years thereafter.”
Now the NBCSP languishes and there is a very real potential that the money spent to date, around $125 million, will be wasted, unless funds are forthcoming in the 2011-12 budget.
Almost six years have elapsed since this program began but the piecemeal approach rollout meant it was fraught from the beginning.
It was poorly targeted to those most at risk and lacked an implementation plan, adequate resources, and effective communication mechanisms with the public and the doctors who treat them.
The funding was considerably less than the real costs of a full program, and this constrained implementation options. For example, no specific federal funding was provided to cover the costs of follow-up colonoscopies (an examination of the colon using a minute camera) for people with positive FOBTs.
There were also significant deficiencies in the ability to track the outcomes from colonoscopy and from pathology on samples taken. Many patients were lost to follow-up, which means the success and the cost-effectiveness of the program can never be accurately established.
Even worse, it can mean that people with treatable cancers may fail to get early medical care.
The program now needs more than just funding. It needs a renewed commitment to full implementation and ongoing support.
The screening programs for cervical and breast cancer were both fully rolled out within five years; there is no reason why this cannot be the case for the screening program for bowel cancer, which claims more lives.
Despite its imperfect operation, over the past five years the NBCSP can be credited with alerting doctors to non-symptomatic polyps, making early cancer diagnoses, and saving lives.
By the Department of Health and Ageing’s own estimate, if the Government makes the decision to continue funding NBCSP in the May budget, it will take a minimum of ten months for the program to recommence.
How many Australians will die unnecessarily or face tough and expensive cancer treatments because someone – inexcusably – dropped the ball on a critical, cost-effective, and evidence-based preventive health program?
We have been warned that the May budget will be tight, with strict fiscal rules. But with Australia facing an ageing population, and hence an increased burden of bowel cancer, restoring the NBCSP is a sound investment in the health of all Australians and in the long-term health of the budget.
Read Lesley Russell and Sarah Wenham’s full report here: Why Bowel Cancer Screening is a Needed Health Care Investment, March 2011.