Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Policy implications of risk stratified colorectal cancer screening (#38)

Kathleen O'Connor 1
  1. WA Cancer & Palliative Care Network, WA Department of Health, Perth

Competition for the public health dollar is fierce and the onus on governments for responsible, accountable health expenditure is high.  Good policy development and implementation, underpinned by evidence, can maximise both community and system benefits.

The National Bowel Cancer Screening Program (NBCSP) is a Commonwealth initiative that commenced in 2006 and has expanded over time. From 2020 onwards, biennial screening for Australians aged 50-74 will be in place. The Australian Government estimates 4 million Australians will receive a free immunochemical faecal occult blood test (iFOBT) each year. Recently published outcome analysis of the NBCSP between 2006 and 2010 demonstrates that invitees who did not participate had 171% higher odds of being at a more advanced stage of colorectal cancer at diagnosis than those who participated. However, given only 41% of invitees presently complete their kit; there is significant opportunity for driving program improvements.

Risk stratification for screening holds significant allure in terms of enhanced decision making, improved triage, reduced resource wastage and maximising health benefit. However, a reality check is required when examining the viability of policy changes in a program still trying to build its infrastructure and address access, equity and consistent quality care provision.

Historically, policies supporting the implementation of the NBCSP have been piecemeal and failed to align with the World Health Organisation’s principles for population screening.  This presentation will outline the policy decisions underpinning the NBCSP since 2006. I will discuss the lessons learnt and future considerations for policy development for the NBCSP. The debate over improvements to the NBCSP, including the potential for risk stratification, goal setting and their prioritisation in the ‘real world’ will be summarised.

The good news – good policy necessitates systematic review and evidence-based change – opportunities for improvements are real and continued advocacy and research can drive better screening practices.