GPs & the National Bowel Cancer Screening Program

Monday 31 May, 2010

A video for General Practioners explaining the import role of GPs in promoting the National Bowel Cancer Screening program to their clients. 

Transcript: 

Jan Farelly: I don't know what my life would have been like if I'd not done the test.

Professor James St John: The screening program is important because bowel cancer is so common. Each week in the country, on average, 80 Australians will die and in fact Australia and new Zealand have the highest rates for bowel cancer in the whole world.

National Bowel Cancer Screening Program - the role of general practice.

Professor James St John (Gastroenterologist, Senior Honorary Associate of Cancer Council Victoria): Bowel cancer is a very common cancer. It's the second most common internal cancer in this country. As a cause of death from cancer, it's second only to lung cancer.

Faecal Occult Blood Testing is a very effective method of screening a population. We need a test that can be performed by 5 million people. We have the highest level of evidence that it reduces the number of deaths.

The NHMRC guidelines, and these are the official national guidelines are that healthy people over the age of 50 should have screening for bowel cancer based on faecal occult blood testing and they're advised to have the test once every 2 years.

Dr Graeme Jones (General Practitioner and bowel cancer survivor): My circumstances when I decided to take the test were that I got sent the kit a couple of weeks after my 65th birthday. As a GP I felt that this was a really important test to do anyway, but had had a colleague who had died in his early 50s of bowel cancer not long before that, so I did the test within a few days of it arriving.

Allison Peipers (Chair of Cancer Council's National Bowel Cancer Screening Committee): The program wouldn't be able to operate without GPs. They're really important to its success. One thing that they can do that's really important is help to encourage participation. We know that a GP saying that bowel cancer screening is a good thing to do will really help encourage patients to get involved.

Dr Graeme Jones: I think it's important for the over 50s to take the test because colorectal cancer or bowel cancer becomes more common the older you get and at 50 people reach the stage where it happens commonly enough to warrant screening. The other big issue with it is that we can either pick up lesions that can lead on to a cancer at a later stage, or pick up very early cancers at a stage where they're curable.

Jan Farelly (Program participant and bowel cancer survivor): Well, I saw the specialist and I had a colonoscopy and he said that I needed to have an operation. I had an laparoscopic right colectomy done, which was removal of part of the bowel. When they sent it away to do a biopsy they found there was a cancer there and it had gone through the bowel and into the lymph nodes, which meant I did need to have chemo.

Promoting participation

Allison Peipers: We're hoping that GPs actually instigate a conversation about bowel cancer screening with all their patients over 50.but particularly the patients who are eligible for the national program. They can actually flag with them that they're likely to receive a kit in the mail. They can explain how the kit works and help allay any fears that people might have around screening and whether it's difficult and how it's all done.

Dr Graeme Jones: I think a lot of GPs do miss that opportunity. Again because they're busy doing lots of other things and because a lot of the awareness campaigns and promotion campaigns for colorectal cancer are something that are relatively new and they haven't quite been on GPs' horizon. I must admit before this happened to me it really wasn't in my consciousness at the level that it should have been.

Reporting to the register

Professor James St John: The program is a population screening program, which is integrated with the normal delivery of health care in Australia. It functions with a central register which is based in Medicare. And the register identifies those who are eligible to have screening. It sends out invitations together with an information booklet and consent form and the test kit.

Allison Peipers: It's really important that we get information back to the register. That's our only way of monitoring whether or not the program is successful overall. And it's also the way that we can be confident that everyone who gets a positive is actually followed up with a colonoscopy.

Professor James St John: General practitioners should understand that reporting back is as important to the program as providing participants with correct advice.

Dr Graeme Jones: My advice to GPs who are really, really busy - and we're all really, really busy - is that from a time point of view, promoting this is a very small part of the consultation. It probably only takes a minute or so to do it. Virtually all of my patients now who are in that age group, I check when they're about to turn 50, 55 or 65 and I proactively bring it up and say ‘After you have this birthday you will receive this kit', and encourage them very strongly to do it.

Whole of practice approach

Allison Peipers: There's a lot of information that's available for the GP and the practice in a written form so that it can be handed on to patients. But also we're hoping it's seen as a whole of practice approach to bowel cancer and bowel cancer screening, so the practice nurse can play a role, there can be information in the waiting room, the practice manager could get involved - so everyone can help get the information across.

Margaret McPherson (Practice Manager): The number one thing I would say to practice managers is that this is a really important program. Also they need to ensure that they've got good policies and systems in place. It's also important that they have all of their staff kept informed of any updates, and this just makes the entire process so simple.

Allison Peipers: Within any program, administration is part of it, as the GP knows, and with the National Bowel Cancer Screening Program, they've really tried to simplify the workload for the GP and for practice staff.

Margaret McPherson: With having an online form, it really is a very quick and easy process. But we still have some doctors who use the paper based forms and they're still quite easy to get through.

Allison Peipers: If I were to leave general practice with one key message, it would be that bowel cancer screening is effective in saving lives.

Professor James St John: It could reduce the number of deaths from around 80 per week, down to 30 or 40 per week, but that will depend on participation, and general practitioners have a huge influence on patient's attitude and on their likelihood to participate in the program.

For further information about the National Bowel Cancer Screening Program:
www.cancerscreening.gov.au
NBCS info line: 1800 118 868
FOBT Helpline: 1300 738 365
bowelscreen@medicareaustralia.gov.au

See our GP program pages for further resources for general practice, or call the Cancer Council Helpline on 13 11 20.

Updated: 31 May, 2010