Letters
Digestive system diseases Environmental health
Volume 191 - Issue 4

Making sense of differing bowel cancer screening guidelines

Authors:  Terry D Bolin, Melvyn G Korman and Alistair E Cowen

Med J Aust 2009; 191 (4): 239-240. || doi: 10.5694/j.1326-5377.2009.tb02771.x
Published online: 17 August 2009
Download PDF (57 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: The recent withdrawal of faulty faecal occult blood testing (FOBT) kits by the government highlights the flaws in the National Bowel Cancer Screening Program (NBCSP), with 475 000 kits needing to be replaced. In their recent editorial,1 Ee and Olynyk attempted to persuade us that the NBCSP, which has now temporarily suspended the issuing of new invitations to participate, is both rational and appropriate for an affluent country such as Australia.

The facts about bowel cancer mortality are not disputed — it is second only to lung cancer, equating to about 12 Australian deaths per day from a potentially preventable cancer. There are only two serious contenders for bowel cancer screening: FOBT and colonoscopy. Annual FOBT has the potential to reduce mortality by 15% (realistic) to 33% (optimistic).2 Colonoscopy is both diagnostic and preventive, with a predicted reduction in mortality of 76% (realistic) to 90% (optimistic).3 Recent United States guidelines advocate colonoscopy at 10-yearly intervals as the test of choice.3

Cost and potential mortality are two major issues raised by proponents of FOBT versus colonoscopy. However, Australian data using all costs, including infrastructure, colonoscopy, surgery, pathology, anaesthesia, chemotherapy and disinfection, have shown that 10-yearly colonoscopy is of equal cost–benefit to annual FOBT.4

A recent publication from Germany highlights some important facts.5 In a study of 269 144 colonoscopies, the completion rate (ie, reaching the caecum) was high, at 97.3%. The perforation rate was low (0.02%), as was the incidence of bleeding (0.16%), though this was predictably greater in those requiring polypectomy (0.8%). There were no deaths attributable to perforation or bleeding. Colonoscopy is therefore a rational option for screening, with the potential for prevention — a feature not shared by FOBT.

The NBCSP’s letter of invitation and FOBT kit are sent only to individuals aged 50, 55 and 65 years. It ignores other age groups and gives no educational advice about alternative strategies such as colonoscopy. Ee and Olynyk1 clearly believe that centrally organised government screening programs are to be preferred, and they disapprove of colonoscopy screening “driven by patients”.

Recent case series show colonoscopy to be safe and to have a higher completion rate than older series.5 Current initiatives in Australian colonoscopy training programs should improve safety and completion rates further.

For those with no active interest in their health, centralised, directive programs are likely to be the most effective. For the informed, however, discussion about lifestyle changes, screening programs and healthy dietary alternatives should be their right.

Authors

  • Terry D Bolin1
  • Melvyn G Korman2
  • Alistair E Cowen3
  • 1. Gastrointestinal and Liver Clinic, Sydney, NSW.
  • 2. Monash Medical Centre, Melbourne, VIC.
  • 3. Royal Brisbane Hospital, Brisbane, QLD.

Correspondence: kerrie@terrybolin.com

References

View this article on Wiley Online Library

More like this

Digestive system diseases Research 18 August 2026 Open Access

Early-Onset Colorectal Cancer With Liver-Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real-World Clinical and Molecular Data From an Australian National Database (2009–2024) to Guide Treatment Planning

Savio G. Barreto, Christos S. Karapetis, Shahid Ullah, Matthew Burge, Susan Caird, Angus Campbell, Azim Jalali, Ross Jennens, Muhammad A. Khattak, Belinda Lee, Stephanie H. Lim, Shehara Mendis, Louise Nott, Timothy J. Price, Jeremy D. Shapiro, Jeanne Tie, Javier Torres, Colin Williams, Rachel Wong, Vanessa Wong, Peter Gibbs

Digestive system diseases Guideline summary 20 October 2025 Open Access

Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations

Jacob George, Nicole L Allard, Stuart K Roberts, Leon A Adams, Jane Davies, Behzad Hajarizadeh, Jennifer H MacLachlan, Suzanne E Mahady, Rosalie Altus, Catherine Brown, David C Fry, Belinda Greenwood‐Smith, Natali Smud, Patricia C Valery, Nafisa Yussf, Kate Broun, Denise Campbell, Karen Canfell, Chelsea Carle Harrison, Victoria Freeman, Paul Grogan, Catherine Holliday, Suzanne Hughes, Anna Kelly, Cathelijne Kemenade, Claire Latumahina, Amanda McAtamney, Megan Varlow, Joachim Worthington, Susan Yuill, Eleonora Feletto

View more