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Bowel cancer

What is the bowel, and how does it work?

The bowel is part of the digestive system, which is also called the gastrointestinal (GI) or digestive tract. The digestive system starts at the mouth and ends at the anus. It helps the body break down food and turn it into energy. It also gets rid of the parts of food the body does not use. This solid waste matter is called faeces (also known as stools, or poo). The bowel is made up of the small bowel and the large bowel.

More information about bowel cancer.

What is bowel cancer?

Bowel cancer is cancer in any part of the large bowel (colon or rectum). It is sometimes known as colorectal cancer and might also be called colon cancer or rectal cancer, depending on where it starts. Cancer of the small bowel is very rare and is usually called ‘small bowel cancer' or ‘small intestine cancer'.

Bowel cancer grows from the inner lining of the bowel (mucosa). It usually develops from small growths on the bowel wall called polyps. Most polyps are harmless (benign), but some become cancerous (malignant) over time.

If untreated, bowel cancer can grow into the deeper layers of the bowel wall. It can spread from there to the lymph nodes. These small, bean-shaped masses are part of the body's lymphatic system. If the cancer advances further, it can spread (metastasise) to other organs, such as the liver or lungs.

In most cases, the cancer is confined to the bowel for months or years before spreading.

More information about bowel cancer.

How common is bowel cancer?

80 Australians die from bowel cancer every week. Bowel cancer is Victoria's third most commonly diagnosed cancer and the second most common when it comes to cancer deaths.

In 2015 3,810 Victorians were diagnosed with bowel cancer, 55% of whom were men. Bowel cancer accounted for 12% of all cancers diagnosed and 13% of cancer deaths in Victoria.

Who is at risk of bowel cancer?

Bowel cancer can occur at any age, but the risk is greater for men and women over the age of 50. Other factors that can also increase your risk include:

  • lifestyle factors: being overweight, doing little physical activity, a diet high in fact or processed and red meats, drinking alcohol or smoking
  • some bowel disease: including ulcerative colitis and Crohn's disease
  • strong family history of bowel cancer.

What are the symptoms of bowel cancer?

Bowel cancer often develops without symptoms, but it is important to see your doctor if you notice any of the following:

  • any sign of blood after a poo
  • change in your poo that won't go away
  • the feeling that your bowel is not empty after going to the toilet
  • stomach pain
  • unexplained weight loss, tiredness, weakness or breathlessness.

The home screening test is not suitable for people with these symptoms. If you notice any symptoms it's important that you speak to your doctor.

How is bowel cancer diagnosed?

If you receive a positive result from a home screening test you will be referred to your GP for further tests.

A positive result means that traces of blood were found in the samples you sent to the pathology lab. Blood may be due to other conditions, and it doesn't mean you necessarily have cancer, but it does need to be investigated.

Find out more about how bowel cancer is diagnosed.

If your test result is positive, you will receive a letter asking you to speak to your doctor about follow-up tests, usually a colonoscopy, to determine the cause.

If your test is negative you will be invited to re-screen in two years.

Where can people with a bowel cancer diagnosis get support?

Cancer Council Victoria provides a range of free information and support services to help manage the impact of cancer.

You can speak with an experienced and understanding Cancer Council nurse for a confidential conversation about anything cancer related.

This may include to:

  • get access to information
  • connect with support services for financial, legal, workplace, transport, accommodation and respite needs
  • find out about one-on-one or group support from others who've been through similar experiences (over the phone, online or in person).

You can access these services whether you have cancer, have had it in the past, or are concerned about your cancer risk. Family, friends and colleagues are welcome to call for information and support.

Call 13 11 20 or email a cancer nurse to find out more


Who needs to screen for bowel cancer?

The risk of bowel cancer increases after the age of 50.

Cancer Council recommends that people aged between 50 and 74 who do not have symptoms or a strong family history of bowel cancer, do a simple at home test every two years.

Regular screening is important because bowel cancer can develop without noticeable symptoms. However, if detected early, 90 per cent of bowel cancers can be cured.

The home screening test is not suitable for people with symptoms or a strong family history of bowel cancer. If you think you have a strong family history, or if you have symptoms, speak to your doctor.

Can bowel cancer run in families?

Sometimes bowel cancer runs in families. If one or more of your close family members (such as a parent or sibling) have had bowel cancer, it may increase your risk. This is especially the case if they were diagnosed before the age of 55, or if there are two close relatives on the same side of your family with bowel cancer.

If you are concerned about your family risk factors, talk to your doctor or call Cancer Council 13 11 20.

What is a strong family history?

It is considered a strong family history if a close relative, e.g. a parent, sibling or child, developed bowel cancer at young age (under 50 years); or if more than one relative on the same side of the family has had bowel cancer.

If you think you have a strong family history of bowel cancer, you should talk to your doctor or call Cancer Council 13 11 20.

What should I do if I have symptoms of bowel cancer or a strong family history?

See your doctor. The home screening test is not suitable for people with symptoms or a strong family history of bowel cancer.

National Bowel Cancer Screening Program

What is the National Bowel Cancer Screening Program?

If you are aged between 50 and 74 years, you will receive a free home test in the mail from the Australian Government as part of the National Bowel Cancer Screening Program. This test will be sent to your address on your Medicare card. If you don't receive a kit, call the National Bowel Cancer Screening Program Information Line on 1800 118 868 to see when you will receive a free at home test.

The program is moving towards two-yearly screening. By 2020, all Australians aged between 50 and 74 will be invited to screen every two years.

For more FAQs about the National Bowel Cancer Screening Program visit their website.

How quickly do you receive the kit after your 50th?

You will receive your free bowel screening kit in the mail within the first six months of your birthday. If you have not received your kit, call the National Bowel Cancer Screening Information Line on 1800 118 868.

How can I screen if I'm not eligible for the program?

If you are not currently eligible for the program, you can still be tested.

Your GP can request a home screening test. The pathology may be subsidised by Medicare. Tests can also be obtained over the counter from some pharmacies, while some pathology services and health organisations provide online options for purchasing a kit.

You should discuss your particular situation and the use of home screening tests with a GP before purchasing one.

How much does the kit cost if I am not eligible for the program?

Costs vary, but generally you can pick up a home screening test for around $30 (plus pathology costs). We recommend that you speak to your doctor before ordering a kit. To find out when you will receive a free kit as part of the National Bowel Cancer Screening Program call 1800 118 868 or visit their website.

Why does the screening program target people aged from 50 to 74?

Screening people aged 50 to 74 provides the greatest health benefit on a whole-of-population basis.

Why isn't the screening program offered to people younger than 50?

Bowel cancer is comparatively rarer in younger age groups. A program that screened large populations of younger people would result in an inappropriately and unsustainably high number of people presenting for clinical investigation, yet with a very low likelihood of having cancer.

If anyone under the age of 50 is concerned about their risk of bowel cancer, if they have symptoms, or a strong family history, they should speak to their doctor.

Why isn't the screening program offered above the age of 74?

The benefits gained from screening in persons aged 75 to 85 who have been previously screened appear to be small compared to the risks associated with screening – particularly from follow-up diagnostic procedures (colonoscopy).

It is recognised that people's medical and health circumstances vary. People aged 75 years or older should talk to their GP about their need for future screening.

The home screening test (FOBT)

How does the home screening test work?

Screening for bowel cancer involves a simple, at-home test called a faecal occult blood test (FOBT). This test looks for traces of blood in the poo which are invisible and could be a sign of bowel cancer. To complete the test, you need to get a tiny sample from two separate poos, put the completed test in the envelope provided and mail it to the pathology lab for analysis.

If you test positive, you will be referred for a colonoscopy for further investigation. Read more about FOBTs.

What if my test is positive – does that mean I have cancer?

A positive result means that traces of blood were found in the samples you sent to the pathology lab. A positive result does not mean that you necessarily have cancer.

Blood may be due to conditions other than cancer, such as polyps or haemorrhoids, but it needs to be investigated.

If your test result is positive, you will receive a letter asking you to speak to your doctor about follow-up tests, usually a colonoscopy, to determine the cause.

If your test is negative you will be invited to re-screen in two years.

Do the home screening tests have an expiry date?

You should complete the test as soon as possible.

Each home test (FOBT) has an expiry date. This can be located on the stickers included with the sample collection tubes.

Once both samples have been collected, it should be posted in the reply paid envelope, containing the collection tubes and the signed Participant Details Form, within 24 hours or as soon as possible.

Are there any restrictions on when samples can be collected?

Yes. Samples cannot be collected if:

  • it is during or within three days either side of a menstrual period
  • you have haemorrhoids (piles) that are bleeding
  • blood is present in the urine or visible in the toilet bowl – if this is the case contact your doctor.

But it is not necessary to change your diet or avoid taking medications before the sample collection.

How should I store the sample?

Keep it in a cool dry place, preferably 2–10 degrees, or in the fridge away from food, until the second sample is taken and until you can post the envelope.

Avoid posting the envelope if it's a very hot day, or post it in an indoor mail box, or post it just prior to collection times.

Screening rates

How many people currently screen for bowel cancer?

Of the 2.6 million people invited between January 2014 and December 2015, 39% participated in the program.

Breakdown by states:

  • NT: 28.6%
  • NSW: 36%
  • VIC: 39.9%
  • WA: 41.1%
  • ACT: 41.8%
  • TAS: 44.3%
  • SA: 45.8%

Is there a target for increasing screening?

Cancer Council Victoria's new campaign could lead to an extra 20,000 Victorians completing the screening test in 2017.

Cancer Council is committed to increasing screening rates to 50 per cent by 2021.

FAQs for GPs and health professionals

What type of FOBT is used as part of the national program?

The national program uses immunochemical tests.

There are two main kinds of FOBTs – guaiac tests and immunochemical tests. Guaiac tests ask people to change their diets and stop taking some kinds of medication before the test. With immunochemical tests, there's no need to change diets or medication.

Although no screening test is 100% accurate, the FOBT is currently the most widely available and well trialled screening test for bowel cancer.

How accurate is the national program FOBT?

A 2014 study by the Australian Institute of Health and Welfare found that the immunochemical FOBT used in the program has a high degree of accuracy (estimated 83% sensitivity and 93% specificity).

A July 2015 Healthpact report  found that the immunochemical FOBT, as used in the program, is the best performing screening test for use in population screening.

Read more about the National Program evidence base.

When will my patient receive a home screening test through the national program?

You can find out when a patient is eligible to receive a kit using the National Bowel Cancer Screening Program age eligibility matrix by Year of Birth.

Australians turning 50, 54, 58, 60, 62, 64, 66, 68, 70, 72 and 74 in 2018 will receive a free FOBT in the mail.

The test will be sent to their address registered with Medicare.

More age groups will be next year and by 2020, the test will be available free (once every two years) to all Australians aged 50 to 74.

What information will my patient receive from the national program?

Eligible people receive a pre-invitation letter near their birthday, followed by an invitation pack.

The kit includes an immunochemical faecal occult blood test (FOBT) kit, instructions and a patient details and consent form, which asks them to nominate their GP for management of their results.

View Department of Health's Participant screening pathway to find out when eligible people will receive contact from the National Bowel Cancer Screening Program.

What happens if my patient receives a positive FOBT result?

Patients who receive a positive FOBT result will be referred to their GP for further investigation.

As a GP, your role includes:

  • encouraging the eligible patients to complete the home screening test when they receive it in the mail
  • assessing those with a positive result and refer them for further examination as clinically indicated, for example a colonoscopy
  • indicating whether a patient referred for colonoscopy is a program participant to assist with reporting to the Program Register. Program stickers are available by calling the Information Line on 1800 118 868
  • notifying the Program Register of referral/non-referral for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the program's GP Assessment Form by fax, post or electronically. Provision of information will attract a payment
  • managing individuals identified as being at increased risk of bowel cancer in accordance with the National Health and Medical Research Council (NHMRC) Guidelines.
  • informing individuals at average risk, or slightly above, that the NHMRC Guidelines recommend screening at least once every two years from the age of 50.

What details do my patients need about me to nominate me as their GP on their consent form?

The patient will provide the GP name, medical practice name and address. The provider number is optional.

What happens if my patient does not nominate me or any GP on their consent form?

A GP will only be notified if they are nominated by the patient. If they do not nominate a GP, only the participant will receive a letter notifying them of the result.

Where can I find out more information about colonoscopy referrals?

Victoria has established a designated provider model to ensure timely access to colonoscopy in public health services for National Bowel Cancer Screening Program participants with a positive FOBT result.

Access the model.

You can also access: 

For more information on the Victorian National Bowel Cancer Screening Pathway, contact the Quality and Liaison team on 03 8417 6825 or visit the Department's bowel screening webpage.

What if my patient is aged between 50 and 74, but not currently eligible for the national program?

Some patients who are not eligible for the national program may be suitable for, or wish to participate in, self-funded faecal occult blood testing.

If your patient is aged between 50 and 74, contact the National Bowel Cancer Screening Program on 1800 118 868.

There are also a number of companies who offer self-funded screening in Australia. An immunochemical FOBT kit can be purchased from some pharmacies or from other third party providers such as pathology providers.

Until the program has implemented biennial screening, you should advise your patients who are participating in the program to undergo FOB testing before they receive their next kit from the national program.

If a person has an existing bowel condition, should they still participate in the National Bowel Cancer Screening 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;
    they should not participate in the program at this stage.

Can the at home test be completed at the GP clinic?

The at home test is designed to be completed in the privacy of your own home. As samples are needed from two separate poos, it is easier to do this at home.

Why should I promote participation in the national program?

Currently only 39.9 per cent of Victorians participate in the National Bowel Cancer Screening Program, and research consistently demonstrates that a recommendation from a primary care provider to screen for bowel cancer is an important motivator for participation.

We also know that people who have completed the home test once are likely to continue re-screening. Nearly three-quarters (73.5%) of people who completed the kit for the first time reported doing the kit a second time. On the flip side, people who had not completed the kit the first time were very unlikely (17.7%) to participate the second time.

How can I promote participation in my practice?

The National Bowel Cancer Screening Program recommends that GPs promote participation through:

  1. Displaying brochures, flyers and posters: Order Program Resources from the National Bowel Cancer Screening Program
  2. Talking to patients aged 50–74 years about bowel cancer screening: Download Clinical Resources or check when an individual will get a kit
  3. Demonstrating how to use a kit. Demonstration kits can be ordered by mailto:NBCSP@health.gov.au%20-
  4. Sending a letter to 49-year-old patients to encourage participation: Download a template letter
  5. Knowing the program: this series of short videos provides a simplified approach to the NBCSP covering the following topics: What is screening, Classification of risk, Referral to colonoscopy and Case studies. For practice nurses this Webinar is a one-hour online seminar on bowel cancer, screening and how nurses working in general practice can approach bowel screening with patients.
Download infographics to share on social media: Why you need to do the bowel cancer home screening test  |  Bowel cancer risk factors  | No symptoms
Access more information about supporting participation in your clinic.

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