Three times more Australians die each from bowel cancer each year than they do from road accidents. Bowel cancer is the second most common internal malignancy amongst adults in Australia and its 90% curable if detected early enough.
But the tragety is, that only 40% of the time are bowel cancers detected early.
The chances of developing bowel cancer increases as we age, and it can be pretty dramatic. The risk increases four fold between the ages of 40 and 50 and it then doubles every decade after that. So with more than 7 million Australians older than 50 the importance of bowel cancer screening just cannot be underestimated.
The aim of these four videos is to provide Australian general practitioners with a simplified approach to the national bowel cancer screening program.
The first video briefly outlines the bowel cancer screening program and discusses symptoms that are potentially indicative of bowel cancer.
The second video discusses the classification of risk of bowel cancer in the general population who have no symptoms.
The third video gives a more detailed overview of the bowel cancer screening program and discusses its potential impact on your practice.
The fourth and final video presents a number of case studies, which demonstrate a range of age, symptom and family history combinations to help with your understanding of patient suitability for the bowel cancer screening program.
Someone who understands how successful the early detection of bowel cancer can be is colorectal surgeon Associate Professor Paul McMurrick.
In many ways bowel cancer is the ideal disease for a population based screening program. That's because it's common, its treatment and outcome are stage dependent, there exists a long and easily detectable premalignant phase in adenomatous polyps and there are acceptable tests available to the community for detection of these premalignant tumours.
But it's not enough for GPs to simply hope that your patients will be appropriately dealt with by the program. For this Program to be successful, it is critically important that GPs to be aware of how the program operates, what its guidelines are and how to assess the risk of bowel cancer for all your adult patients over 50.
Not everyone is included in the program, and FOB testing is not appropriate for everyone. Suitability for screening for bowel cancer should be performed on all patients over the age of 50.
When you consider that simply raising the FOB screening rate from its current 36% to an achievable 70% will save over 2000 lives a year, the benefit of raising the awareness of bowel cancer with your patients is obvious.
The National Bowel Cancer Screening Program was initiated by the Australian Government in 2006, to help detect bowel cancer early and of course reduce the number of Australians who die each year from the disease.
There have been many international studies which have provided level one evidence supporting the use of a national bowel cancer screening programs. The effects of these is predicted to result in a one third reduction in the number of deaths from bowel cancer each year.
Currently, the National Program sends free faecal occult blood test kits to all eligible Australians at different age groups. By 2020 though, the program will be fully implemented sending kits every two years to Australians aged between 50 and 74 years, and that's of course, in line with accepted guidelines.
The trouble is the uptake of this program is far too low at around 36%, and this participation rate lags well behind other countries, and that's despite public education and awareness campaigns.
So now, the Victorian Department of Health and Human Services in collaboration with the Monash Cabrini Department of Surgery and Lets Beat Bowel cancer, are launching a GP education program, it's designed to ensure all GPs in Victoria and the rest of Australia are aware of the program, and understand its strengths and requirements. And of course, the other hope is, you will have bowel cancer prevention at the forefront of mind when caring for their patients.
The aim of screening is to reduce the incidence, morbidity and mortality of a specified health condition by investigating patients who have no symptoms. The National Bowel Cancer Screening program includes a question sheet regarding symptoms, but these need to be clarified by both the patient and their GP.
>For all adult patients coming to your practice, as part of your general assessment you should include questions regarding gastrointestinal symptoms as part of any systems review.
There are 4 main symptoms that are potentially indicative of bowel cancer. Every general patient assessment should include these questions:
- Have you been bleeding from the bowel?
- Have you had any sustained or unusual change in bowel habit?
- Are you losing weight suddenly or unexpectedly?
- Are you suffering from any abdominal pains that you would regard as unusual for you?
Obviously, your clinical judgement should be used in assessing the significance of these symptoms in your individual patient, but any patient suffering from any of these symptoms, especially if more than one of these symptoms is present, should be considered for either colonoscopy or specialist referral.
We do of course need to take these in context, and we will discuss some specific case presentations at the end of this video. For example, if a 20 year old male presents, having spent a month backpacking and living on beer and hamburgers, and suffers a single episode of bright bleeding in the setting of straining at stool, the likely yield from further investigation is very low indeed.
Conversely however, a person in their 70s reporting change in bowel habit associated with dark blood loss and abdominal pain clearly requires specialist referral.
It is however imperative for all GPs to question their patients about gastrointestinal symptoms, assess the significance of these symptoms and consider colonoscopy or specialist referral if they are in any doubt about their significance.
It is also important to document the discussion about assessment for gastrointestinal symptoms, including an evaluation of the decision to either proceed with conservative treatment, or offer a colonoscopy, for all adult patients who present with rectal bleeding.
Remember any adult patient is at risk of bowel cancer, regardless of age.
The next video will provide general information regarding the classifications of risk in the general population