Murray PHN Bowel Cancer Screening Project
Bowel Cancer is the second most common cancer affecting Victorian men and women, and there is strong evidence that when bowel cancer is detected early, over 90% of cancers are treatable.
What general practices can do
- You can use the PenCAT tool to identify eligible patients.
- Place bowel cancer posters in nursing consult rooms and behind doors of all toilets. You can print the posters from here.
- Use Cancer Council Victoria's colorectal cancer Optimal Care Pathway here.
- Consider the possibility of practice nurses raising the pathology request during care plan and health assessment appointments, and then get sign off by GP at end of visit
- Start small - target one GP in your practice and support his/her performance over a period or have a practice competition for the GP with the most FOBT results in a month
- Standardise your pathology request coding; use only FOBT, FOBT1, FOBT2 or FOBT3 so that you can track activity
- Identify eligible patients and consider doing a staggered mail-out campaign to eligible patients (for example, target the 50 year olds first, then 55 year olds, 60 and 65 year olds over a period) encouraging them to ask about the FOBT test at their next visit. Sample proforma letters for a mailout can be downloaded here...
These letters are intended as prompts for people who may have received a National Bowel Cancer Screening Program (NBCSP) kit. You can amend the letters to suit your practice.
Service providers can receive payments for notification of information to the National Bowel Cancer Screening Program Register. Payment account details for service provider forms can be accessed here.
Frequently Asked Questions (FAQs)
Are there any restrictions on when samples can be collected?
Yes. Samples cannot be collected if there is any active bleeding for example: it is during or within three days either side of a menstrual period; haemorrhoids (piles) are bleeding; or blood is present in the urine.
How accurate are the results?
Because cancers and precancerous growths only bleed intermittently it is possible that the FOBT will miss one. Two samples for collection greatly increases the sensitivity of the result.
How often do I do FOBT in patients with a family history?
Yearly FOBT plus colonoscopy according to their risk. Most people who develop bowel cancer have no family history of bowel cancer. However, people with a history of bowel cancer or in one or more first degree relatives (parents, siblings, children) are at an increased risk. This risk is increased even further in people with a history of bowel cancer in:
- One or more first degree relatives (parents, siblings, children) younger than age 55
- Two or more first degree relatives (parents, siblings, children) at any age
How often should screening take place in people with no family history?
Every two years.
What are the costs for the kits?
- Clients on the National Bowel Screening Program - Free
- From some pathology collection centres on referral from a GP - Free
- Pharmacy and some pathology collection centres - $25 to $40
Pathology FOB test MBS Items: Item #69674 is a maximum of three examinations on specimens collected on separate days in a 28 day period; Item #66767 is for two examinations performed on separately collected and identified specimens and Item #667700 is for three examinations performed on separately collected and identified specimens.
What do I do if I get a positive result? Do I re-screen, refer immediately for colonoscope/gastroscope or refer to a specialist for review?
About one in 14 people will have a positive result. The presence of blood may be due to conditions other than cancer, such as polyps, haemorrhoids, or inflammation of the bowel, but the cause of the bleeding, needs to be investigated.
Check the Bowel Cancer Risk and Screening Pathway here.
What if a person has an existing bowel condition, should they still participate in the program?
In most cases, a person who has an existing bowel condition should still participate in the program. However, if a person has received an invitation to participate in the program but: has had a bowel condition in the last 12 months which is currently under treatment; or has had a colonoscopy within the last year; or is scheduled for a colonoscopy in the next few weeks; you can call the NBCSP Information Line on 1800 118 868.
What if the patient is in the bowel screening program?
If the patient has a positive FOBT result, you will need to notify the National Bowel Cancer Screening Program Register of referral/non referral for colonoscopy or other bowel examination by completing and returning a GP Assessment Report available here.
Return by FAX to 1800 115 062;
By mail to: NBCSP Register, Reply Paid 83061 Hobart TAS 7001 or online here.
What if the results comes back inconclusive?
An inconclusive or incomplete FOBT result may occur for a number of reasons, including incorrect use of the test, too much faeces in the samples, a significant delay between taking the two samples or a delay in sending the test to the pathology laboratory. For people who have an inconclusive or incomplete FOBT, the test should be repeated.
What is the difference between kits?
Immunochemical kits are not affected by drugs and diet. Guaic kits are the ones generally offered by Rotary. These require dietary and medication restrictions. For example, the patient cannot be on NSAIDS, high dose aspirin and Vitamin C. With regards to dietary restriction, if the client reads the instructions, and if necessary contacts the Bowelscan Information Service 1300 779 694 then diet is not going to be a problem.
Who should be screened?
In accordance with evidence-based medical guidelines, Bowel Cancer Australia recommends screening for bowel cancer for both men and women aged 50 years and over; with no bowel cancer symptoms; and no personal/family history of bowel cancer or polyps.
NBCSP Age Eligibility and Victorian Colonoscopy Referral Information
The Department of Health and Human Services recognises the key role that GPs play in the National Bowel Cancer Screening Program by endorsing the program to patients and by managing patients' positive Faecal Occult Blood Test results. To support the role of GPs in the Program, resources are now available:
- NBCSP age eligibility matrix by Year of Birth
- Victorian colonoscopy referral information - included with positive FOBT result letters from the Program
- Pre-populated NBCSP GP Assessment Report templates:
- Victorian patient information flyer - included with positive FOBT result letters from the Program.
The Victorian colonoscopy referral information lists the 19 public health services that have agreements to provide colonoscopy services for Program Participants within 30 days for from referral. For more information on the Victorian NBCSP pathway, contact the Quality and Liaison team on 03 8417 6825 or visit the Department of Health's bowel screening webpage.
- BCSP update | GP letter_Feb2015 (477 KB)
- NBCSP update | Practice Nurse letter_Feb2015 (404 KB)
- Patient flyer_March2015 (63 KB)
- DNA test no substitute for faecal bowel cancer screening
- FOBT three times more sensitive to earliest stages of disease
- National Bowel Cancer screen should be GPs responsibility
- RACGP Guidelines for preventive activities in general practice 8th edition - 9.6 Colorectal Cancer (CRC)
- Clinical guidelines
- Bowel Cancer Awareness website
- Cancer Victoria website
- Cancer Council
- Bowel Cancer Atlas of Australia report
- RAS biomarker testing - for advanced Bowel Cancer patients
- Optimal cancer care for people with colorectal cancer and the corresponding Quick Reference Guide
- National Bowel Cancer Screening Program Factsheet May 2013 (45 KB)
- National Bowel Cancer Screening Pathway 2013 (552 KB)
- Bowel cancer screening and prevention_PowerPoint presentation (2.8 MB)
- Bowel Cancer Video (1.9 MB)
This project is one of two arms of a project addressing consumer needs in the local government areas of City of Greater Bendigo and Loddon Shire. The Department of Health, through its Bendigo regional office, has engaged Bendigo Community Health Services to conduct a community engagement program using social media to target selected population groups. The Department of Health, through its central office, has engaged General Practice Victoria to work with Murray PHN to develop and implement a whole-of-general-practice engagement strategy.