Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening rates for each CRC screening modality; level of screening in accordance with national screening guidelines.
Results: Of the 1117 participants (70%) who returned a questionnaire, 777 were deemed asymptomatic and eligible for analysis. Overall, 63% of respondents had ever received any CRC testing. Forty-three per cent had ever had a faecal occult blood test (20% screened in the previous 2 years); 30% had ever had a colonoscopy (16% screened in the previous 5 years); and 7% had ever had a sigmoidoscopy (1% screened in the previous 5 years). Rates of adherence to screening guidelines were 21% for respondents who were at or slightly above average risk, and 45% for respondents who were at moderately increased or potentially high risk.
Conclusions: Rates of CRC screening remain low. The screening rate for colonoscopy was particularly high among people who were at or slightly above average risk, despite such screening not being endorsed in the guidelines. Effective strategies to improve rates of CRC screening and appropriate use of colonoscopy are required across the entire at-risk population.
- 1. Australian Institute of Health and Welfare. Australian cancer incidence and mortality (ACIM) books. Bowel cancer for Australia. Canberra: AIHW, 2011. http://www.aihw.gov.au/acim-books/ (accessed Feb 2012).
- 2. Australian Institute of Health and Welfare. Cancer in Australia 2010: an overview. Canberra: AIHW, 2010. (AIHW Cat. No. CAN 56; Cancer Series No. 60.) http://www.aihw.gov.au/publication-detail/?id=6442472459 (accessed Feb 2012).
- 3. National Cancer Institute. Surveillance Epidemiology and End Results. SEER Stat Fact Sheets: Colon and rectum. http://seer.cancer.gov/statfacts/html/colorect.html (accessed Feb 2012).
- 4. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-1371.
- 5. Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal occult blood test. Lancet 1996; 348: 1467-1471.
- 6. Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of fecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477.
- 7. Mandel JS, Church TR, Bond JH, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000; 343: 1603-1607.
- 8. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-1633.
- 9. Brenner H, Chang-Claude J, Seiler CM, et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30.
- 10. Ransohoff DF. How much does colonoscopy reduce colon cancer mortality? Ann Intern Med 2009; 150: 50-52.
- 11. Crespi M, Stigliano V, Assisi D. Current trends in screening and secondary prevention of colorectal cancer. Hepatogastroenterology 2001; 48: 1635-1640.
- 12. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981.
- 13. Ee HC, Olynyk JK. Making sense of differing bowel cancer screening guidelines [editorial]. Med J Aust 2009; 190: 348-349.
- 14. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Guidelines for the prevention, early detection and management of colorectal cancer. Sydney: The Cancer Council Australia and Australian Cancer Network, 2005. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp106_0.pdf (accessed Feb 2012).
- 15. Pignone MP, Flitcroft KL, Howard K, et al. Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia. Med J Aust 2011; 194: 180-185.
- 16. Anderson R, Haas M, Shanahan M. The cost-effectiveness of cervical screening in Australia: what is the impact of screening at different intervals or over a different age range. Aust N Z J Public Health 2008; 32: 43-52.
- 17. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: annual monitoring report 2009. Canberra: AIHW, 2009. (AIHW Cat. No. CAN 45; Cancer Series No. 49.) http://www.aihw.gov.au/publication-detail/?id=6442468298 (accessed Feb 2012).
- 18. Shapiro JA, Seeff LC, Thompson TD, et al. Colorectal cancer test use from the 2005 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2008; 17: 1623-1630.
- 19. Cockburn J, Paul C, Tzelepis F, et al. Screening for bowel cancer among NSW adults with varying levels of risk: a community survey. Aust N Z J Public Health 2002; 26: 236-241.
- 20. Thomas RJ, Clarke VA. Colorectal cancer: a survey of community beliefs and behaviours in Victoria. Med J Aust 1998; 169: 37-40.
- 21. Weller DP, Owen N, Hiller JE, et al. Colorectal cancer and its prevention: prevalence of beliefs, attitudes, intentions and behaviour. Aust J Public Health 1995; 19: 19-23.
- 22. Carrière P, Baade P, Newman B, et al. Cancer screening in Queensland men. Med J Aust 2007; 186: 404-407.
- 23. Weber MF, Banks E, Ward R, Sitas F. Population characteristics related to colorectal cancer testing in New South Wales, Australia: results from the 45 and Up Study cohort. J Med Screen 2008; 15: 137-142.
- 24. McEvoy M, Smith W, D’Este C, et al. Cohort profile: The Hunter Community Study. Int J Epidemiol 2010; 39: 1452-1463.
- 25. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detction of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: 130-160.
- 26. Canadian Task Force on Preventive Health Care. Colorectal cancer screening. Recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2001; 165: 206-208.
- 27. Sewitch MJ, Fournier C, Ciampi A, Dyachenko A. Colorectal cancer screening in Canada: results of a national survey. Chronic Dis Can 2008; 29: 9-21.
- 28. Seeff LC, Nadel MR, Klabunde CN, et al. Patterns and predictors of colorectal cancer test use in the adult US population. Cancer 2004; 100: 2093-2103.
- 29. McGregor SE, Hilsden RJ, Li FX, et al. Low uptake of colorcetal cancer screening 3 yr after release of national recommendations for screening. Am J Gastroenterol 2007; 102: 1727-1735.
- 30. Sewitch MJ, Fournier C, Ciampi A, Dyachenko A. Adherence to colorectal cancer screening guidelines in Canada. BMC Gastroenterol 2007; 7: 39.
- 31. Harris JK, Froehlich F, Gonvers JJ, et al. The appropriateness of colonoscopy: a multi-center, international, observational study. Int J Qual Health Care 2007; 19: 150-157.
- 32. Vader JP, Pache I, Froehlich F, et al. Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc 2000; 52: 593-599.
- 33. Adler A, Roll S, Marowski B, et al. Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum 2007; 50: 1628-1638.
- 34. Cancer Council Australia. Cancer Council Australia pre-budget submission, 2011–12. Bowel cancer screening: program expansion would reduce Medicare and PBS costs – and save lives. http://www.cancer.org.au/File/PolicyPublications/Submissions/Cancer_Council_Australia_prebudget_submission_2011_12.pdf (accessed Feb 2012).
- 35. Viiala CH, Zimmerman M, Cullen DJ, Hoffman NE. Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J 2003; 33: 355-359.
- 36. Khoja S, McGregor SE, Hilsden RJ. Validation of self-reported history of colorectal cancer screening. Can Fam Physician 2007; 53: 1192-1197.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.