Among the many announcements ahead of tonight’s Federal Budget was this one of an expansion of bowel cancer screening.
In the article below, Terry Slevin, Education and Research Director at Cancer Council WA, explains some of the background to the announcement, and also suggests that the Ministers responsible “deserve a cuddle”.
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How this “historic milestone” was achieved
Terry Slevin writes:
In 1997, the Australian Health Technology Advisory Committee of the National Health and Medical Research Council published a recommendation that Australia introduce a bowel cancer screening program using Foecal Occult Blood testing. At that time there were three randomised controlled trials which showed a reduction in deaths from Australia’s second biggest cancer killer.
Australia has one of the highest global incidence rates of bowel cancer with recent estimations showing that 1 in 12 Australians are likely to develop the disease before the age of 85. In 2007 there were 14,234 new cases of bowel cancer, representing 13% of all new cases of cancer (excluding non-melanoma skin cancer). That same year, 10% of all cancer deaths, some 4,047 deaths, were attributed to bowel cancer.
Since its introduction in 2006 the National Bowel Cancer Screening program has only targeted people turning 55 and 65 with a one-off test, with 50-year-olds added in 2008.
On Saturday 5 May, the Treasurer, Wayne Swan, and the Minister for Health, Tanya Plibersek, announced $49.7 million over four years to expand the program in preparation for an incremental shift to full implementation.
Thanks to these new budget funds, 60-year-olds will be added next year and 70-year-olds in 2015; the Government plans to thereafter start rescreening everyone aged 50-74 every two years, starting with 72-year-olds in 2017.
Some people are unhappy, suggesting it is too little too late.
The Cancer Council has been campaigning for a full roll out of this life saving program since the implementation of the National Bowel Screening Program in 2006, and of course we’d have liked to see it implemented earlier. But we can only change the future, not the past.
The progressive roll out of the program makes sense. The infrastructure to distribute the kits, do the analysis and promote the program more broadly in the community, as well as the capacity to provide the necessary follow up colonoscopy and other services for those with a positive test needs to be built, carefully and systematically.
Many Parliamentarians, from all sides of politics, have put real time, effort and energy into supporting the program and they should all feel pleased with their efforts as we launch into a tough and tight federal budget.
So how has this historic milestone for cancer screening come about with such a tough budget predicted?
This is a case of good policy triumphing despite, maybe even because of, politics.
Let’s not pretend – screening programs are not cheap. And they keep on going. Once put in place it is extremely hard for any government to undo cancer screening. So the case needs to be clear, sound and built on firm evidence and solid programmatic experience.
And this program ticks all those boxes and more.
But it also needed to be “sold”.
Most recently we launched the “Get Behind Bowel Screening” campaign. More than 24,000 Australians signed up and communicated their support to federal members of parliament of all persuasions.
A committee of people from all state Cancer Councils have been working on this campaign for more than four years. There has been enormous effort invested by the scientists, researchers and clinicians who did the research over 30 years or more. There have been staff, volunteers, very supportive journos, pollies, their staff and many, many more. And of course many other organisations have put their shoulder to the wheel.
The key to this campaign has always been – “play the ball not the man”. That is – stick to the facts, the evidence and the argument. With those on your side, the next vital ingredients are persistence and patience. Sometimes a little bit of nous (sometimes in surprisingly short supply) helps too.
Credit for this success must first go to the people who made the big decision to go down this track. Treasurer Swan, Minister Plibersek and Prime Minister Gillard deserve a cuddle.
But this is “the beginning of the beginning”, to torture a Churchillian notion. There is much work to be done for this to happen the way it should. We need to ensure potential screenees understand the test, its benefits (and some potential harms) and how to go about using it.
We need to build on, and improve, high quality systems to ensure a world class screening program.
And we can do that confident in the knowledge that less people will die from bowel cancer as a result. A worthwhile goal for us all to pursue I’d suggest.
It is easy to be cynical and to grizzle and moan about what is not working. But it should make our collective hearts a little warmer to see the decision making system – for all its flaws – deliver a worthwhile result.
• Terry Slevin is Education and Research Director at Cancer Council WA
I hear what you’re saying, Terry, and let’s hope they get on with it, although I admit to being a member of the ‘too little, too late’ brigade. It is interesting to note that, under the UK system: ‘Your screening programme will start within a few weeks of your 60th birthday (50 in Scotland), and be repeated automatically, every two years until your 75th birthday.’ [http://www.beatingbowelcancer.org/screening] In fact, much of the work of Beating Bowel Cancer acknowledges the need for clear and effective communication around bowel cancer screening, prevention and treatment — including communication which recognises that men and women respond to these things in different ways. Humour is used a lot — they are currently creating a Bowel Movement, and distribute little pin-on badges with a bare bottom in stripey underpants on the front of a ‘Know the symptoms of bowel cancer’ card). Yes, we need a more effective screening program, but we also need to increase the uptake rate, especially among men. What good, exactly, are Australia’s women’s and male health strategies if they are completely ignored in the development and roll-out of major health initiatives? Crucially, we also need to accompany this screening program with some strong, clear, and unequivocal messages across about prevention, in language that ordinary people understand.
I think the passionate, ever-persistent, public health advocates deserve a cuddle too. Thanks for not giving up on this important cause.
More Australians with access to bowel cancer screening – good.
Adding two age groups over three years to a program that was piloted 10yrs ago – average.
Full implementation of the NBCSP by 2034 – catastrophe. (Yes, we are serious! Check the budget papers.)
As we’ve consistently called for full implementation and not seeing that detail in the pre-budget sweetener, our response was measured. See http://ow.ly/aN3aT
Given full implementation will be 32 years since the NBCSP was piloted, we wouldn’t be doing our job if we high fived the Government for that result.
Terry and others might be interested in the new research presented at the Digestive Diseases Week conference today in San Diego about the work of Australian researchers in identifying new biomarkers for bowel cancer risk.
See http://bit.ly/JXCoTW