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These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.
These are activities that require reflection on feedback about your work.
These are activities that use your work data to ensure quality results.
In July, the eligibility entry age for the National Bowel Cancer Screening Program was lowered to 45, but first-time screeners under age 50 need to opt-in. The rationale for the change was two-fold, with guidelines citing both rising incidence rate in adults under 50 and increasing life expectancy.
People diagnosed with bowel cancer via screening are 59% less likely to die from it. However, only 41% of eligible people take part in the screening program—well short of the Australian Government’s target of 55%, says cancer epidemiologist Professor Karen Canfell, chair of the Cancer Council’s Screening and Immunisation Committee.
Professor Canfell says GPs should recommend screening to all average-risk patients aged 45 and over.
“For people with an early-stage cancer, or a precancerous polyp, screening is by far the most effective way to stop—as distinct from delay—progression to later-stage disease.”
The US Food and Drug Administration (FDA) recently approved a new colorectal cancer test (known as Shield), which looks for ‘free-floating’ molecules of cancer DNA in the bloodstream.
A clinical trial with almost 8,000 participants found the test had a sensitivity of 83.1% for detecting colorectal cancer, but only a 13% sensitivity for advanced precancerous lesions.
So is it likely to play a role in Australia?
Professor Canfell has her doubts.
“The Shield blood test is just one of many tests promoted by biotechnology interests,” she says.
“Cancer ‘screening’ in the US is not implemented in the way it is in Australia. The US does not run free organised national screening programs inviting entire populations to participate. The FDA approval is essentially advice to individual clinicians. So the decision on the current evidence regarding the Shield blood test has no significant implications for screening in Australia.”
The limited publicly available evidence about the test suggests it has several shortcomings compared with the iFOBT, she says.
“These include lack of effect for detecting precancerous adenomas and the need for a medical appointment, as compared with someone completing an iFOBT at home.”
“We have published evidence showing that 84,000 lives could be saved in Australia between 2015 and 2040 if screening participation in the NBCSP could be sustained at 60%. Our focus should be on doing more of what is already shown to be effective – and encouraging increased participation in the NBCSP.”
However, gastroenterologist, hepatologist and addiction medicine physician Dr Emily Nash, staff specialist at the Royal Prince Alfred Hospital and a Clinical Associate Lecturer at University of Sydney Medical School, has a different take.
“This is an exciting development in colorectal cancer screening, as a blood test can be much more acceptable to many patients than a stool test and will hopefully result in improved uptake of screening,” Dr Nash says.
“Trial data showed 90% uptake of the test in a real-world setting, and performance was comparable to iFOBT. This might be part of the solution to improving colorectal cancer screening for Australian adults in years to come.”
For now though, Professor Canfell encourages health professionals to discuss screening with their patients, noting that this has been linked to improved screening rates.
When people participate in screening once, they are much more likely to do it again, Professor Canfell notes.
“Rescreening rates are much higher, at over 70%, which shows people who participate realise it’s quick, easy and effective,” she says.
First-time screeners aged 45 to 49 need to apply for their free screening kit by:
They will be added to the screening register and receive their next kit in the mail in two years’ time.
GPs can bulk order iFOBT kits and hand them out to eligible patients, adds Dr Nash, noting they expire after seven months and need to be recorded in the National Cancer Screening Register.
“Demonstration kits can also be ordered for showing patients how easy it is to complete the test.”
People without a Medicare or Veteran’s Card can purchase an iFOBT kit from pharmacies or online.
Download home test kit instructions in 22 languages
Other resources for health professionals (eg checklist for talking to patients)
Resources for health professionals working with Indigenous patients
Information about accessing the NCSR
About the cancer screening programs GP promotion
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