Population bowel cancer screening in Australia involves direct-to-consumer invitations to participate, with limited involvement of primary care until someone has a positive faecal occult blood test. This model assumes a one-size fits all approach and fails to account for variations in colorectal cancer risk. Current participation in the National Bowel Cancer Screening Program is poor with only 41% of people returning the faecal occult blood test kit. Importantly, over one million Australians at average risk of bowel cancer are having unnecessary and potentially harmful colonoscopy screening rather than doing the faecal occult blood test. Greater involvement of primary care in cancer screening programs is associated with higher participation rates.
If we are to implement precision screening for colorectal cancer, this will require involvement of primary care to determine a patient’s risk and promote risk-appropriate screening, including at what age to start and with which screening test. In this presentation I will discuss our research on approaches to implement colorectal cancer risk assessment and tailored screening in primary care, including electronic risk assessment tools (e.g. the CRISP Trial) and genomic testing using a SNP panel. I will discuss the implementation challenges of these different approaches and consider how we might eventually incorporate new models to provide tailored bowel cancer screening in Australia.