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The “pretend” bowel cancer screening program is an opportunity lost

Kathy Flitcroft, from the Sydney School of Public Health at the University of Sydney, has previously described the Federal Government’s policy failures around bowel cancer screening.

The budget’s announcements on bowel cancer screening (as outlined by Cancer Council Australia’s Professor Ian Olver last night) add to her sense that the Government’s commitment evidence-based policy is grounded more in rhetoric than action.

***

Where’s the commitment to evidence-based health policy?

Kathy Flitcroft writes:

The Budget announcement of $138.7 million for the continuation of the current bowel cancer screening program is a clear indication that the ideal of evidence-informed health policy is seriously challenged in Australia.

Health Minister Nicola Roxon recently justified the decision to ignore recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC) to fund six pharmaceuticals on the basis that this money was needed for the bowel cancer screening program.

Those who had demonstrated that the current program was underfunded and inadequate, dared to hope that a better, more evidence-based program was on the way. Unfortunately, this was not the case.

This government has opted to not only ignore the expert opinion of the PBAC, which makes recommendations about placing drugs on the Pharmaceutical Benefits Scheme based on the best evidence, but has then also ignored the pleas of Cancer Council Australia, gastroenterologists and academics who have made a strong case for the need for increased funding for bowel cancer screening.

Done properly, this evidence-based and cost-effective intervention can save not only 1,000 lives a year but can also reduce costs for our overstretched health system.

By continuing to restrict funding of faecal occult blood test (FOBT) screening to those turning 50, 55 and 65, the government has ignored the recommendations from its own National Health and Medical Research Council on how bowel cancer screening programs need to be implemented.

The evidence clearly shows that FOBT screening should be offered at least every two years to those aged over 50.  Many other countries across the world either have or are introducing biennial bowel cancer screening programs.

In contrast, we have a pretend national bowel cancer screening program, which offers one-off screening at 50, then a five-year gap to 55, and then a ten-year gap to 65.

These screening intervals are not based on any evidence (how is a 10 yearly screening interval going to prevent the development of cancer?) but are determined instead by the short-sighted political obsession with cost-saving measures to bring the budget back to the magical surplus.

The tragedy is that many lives will be lost unnecessarily in the interim.

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Comments 4

  1. JimW says:

    Hi Kathy,

    Correct me if I am wrong but I’m pretty sure that just because the Government doesn’t include all age groups in its screening program that people in those age groups can’t get tested. Indeed with bulk billing of visits to the GP at around 75% and pathology tests bulk billed at over 90% I presume that a significant number of people can access these tests at pretty much no out of pocket costs. I understand that the tests are uncomfortable and possibly a little embarrassing but why does this mean that the Government has to divert resources away other worthwhile needs? If the evidence on the value and effectiveness of these tests is so compelling shouldn’t this be enough to get people in to see their doctor and get tested, particularly when the costs are so significantly subsidised?

    And on the issue of “expert committees”, there are lots of experts who make recommendations to Government across a whole range of areas of public policy. Just because the Government doesn’t implement the recommendations doesn’t mean they are ignoring a particular committee, perhaps they are just favouring one committee over another. The Health fraternity need to get over themselves on this issue and realise that they are in the mix with all the other hungry policy mouths and that sometimes, despite the best of evidence, it won’t be their turn this time around.

    Regards

    Jim

  2. Melissa Sweet says:

    Kathy Flitcroft asked me to post this comment on her behalf, in response to the comment above:

    Hi Jim,
    Thanks for your comment. As you point out, people can go to their GP and ask for an FOBT. If the visit is bulk billed, this may cost them nothing.

    However, even if we assume that there are no out-of-pocket costs for the patient, I’m not sure how going to the GP and billing the government for that visit, the cost of the test and the pathology costs is saving the government any money – they are still paying, whether the testing is conducted as part of a national program or not.

    There are several reasons why offering FOBT screening as part of a national program is preferable. Firstly, the test kits are sent directly to the person’s home (the test must be done at home and not in a doctor’s surgery as it requires taking samples of two subsequent bowel motions). This saves GP time and resources in dealing with people who do not need to see a GP to be tested, and saves the government money in funding the GP visit.

    Secondly, if people undergo ad hoc screening via their GP there is no information entered into a national database about the test being taken, the test result, the follow up procedures if the test was positive, pathology results from those follow-up procedures or information about treatment details. This means there is no coordinated way of knowing who has been tested and what the outcomes were, which is important to assess how effective the testing has been at a population level.

    Thirdly, as you point out, people can find the test embarrassing (it is not uncomfortable) which is why they should be provided with the information about the potential benefits and harms of testing (information that accompanies the test kit), and be allowed to make their own mind up about doing the test.

    However, given the evidence that bowel cancer screening can save up to 1,000 lives a year, it is irresponsible to not give people the opportunity to be screened. The government has acknowledged this fact by introducing a partial bowel cancer screening program, but by not funding it properly, they are doing the population a disservice. This is not just my opinion, but a view that is shared by the Cancer Council of Australia, among many others.

    As for your point on expert committees, you are correct that there are many experts who make recommendations to government. The point about the PBAC is that it is a committee that was created by the government specifically to advise them about what pharmaceuticals are cost-effective and worthy of inclusion in the PBS.

    The government does have the right to overrule PBAC recommendations. However, if the government chooses to do so, I believe they should also abandon the rhetoric that evidence is a primary concern in their deliberations.

    Cheers
    Kathy

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