Colonoscopy follow-up and median time

Published

22 Jun, 2020

Australia has one of the highest rates of colorectal cancer in the world and is the third most commonly diagnosed cancer among Aboriginal and Torres Strait Islander people (after lung cancer and breast cancer). Several risk factors have been identified which may contribute to bowel cancer.¹ These risk factors include, modified risks i.e., excess body fat, physical inactivity, poor diet (e.g. high consumption of processed meats), high alcohol consumption and smoking. As well as risk such as family history and genetic susceptibility, and exposure to ionising radiation.¹

Australia commenced an organised program of colorectal (bowel) cancer population screening in 2006, the National Bowel Cancer Screening Program (NBCSP). Indicators of the performance of this Program include the proportion of positive FOBT cases having a follow-up diagnostic assessment (colonoscopy), and the elapsed time between a positive FOBT and the assessment.¹It is desirable that follow-up diagnostic assessments occur in a timely manner, thus minimising potential harms from delayed diagnosis and treatment.¹ This indicator should not be considered a hospital wait time indicator, as there are various steps, decisions and wait times in the pathway between a positive screen and a diagnostic assessment.

It should be noted that the reporting of colonoscopies to the NBCSP is not mandatory and there is an unknown degree of under-reporting that may affect the data. The data shown in this analysis are based on information recorded in the Program Register only. Caution is advised when using this data as it may not reflect the true population.

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Notes

• Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
• Reporting of follow-up assessments is not mandatory.
• When presenting data of Australian Aboriginal and Torres Strait Islander peoples we will be respectfully using the term Indigenous Australians.

Median time between a positive screen and diagnostic assessment for Aboriginal and Torres Strait Islander people, by year
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Notes

• Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
• Rates are not age-standardised.
• When presenting data of Australian Aboriginal and Torres Strait Islander peoples we will be respectfully using the term Indigenous Australians.

Proportion of the eligible Aboriginal and Torres Strait Islander population invited who had a follow-up colonoscopy within 360 days of a positive FOBT by year

About this measure

Between 2010 and 2014, 840 new cases of colorectal cancer were diagnosed in Aboriginal and Torres Strait Islander people and between 2012 to 2016, 213 Aboriginal and Torres Strait Islander deaths were attributed to colorectal cancer.³ Additionally, males are more likely to diagnosed with and die from colorectal cancer compared to females.³

It is estimated that colorectal cancer will remain the second leading cause of cancer death in Australia (after lung cancer).¹ Colorectal cancer may be present for many years before showing clear symptoms, but non-visible bleeding of the colon and rectum can occur in the precancerous stage.¹ The FOBT is a non-invasive test that detects microscopic amounts of blood in a faecal sample. Regular screening using the FOBT and treatment of FOBT-positive cases can reduce mortality due to colorectal cancer by up to one-third.⁴ A positive FOBT result requires a follow-up procedure to determine an accurate diagnosis. Colonoscopy is currently considered the most accurate procedure, because it enables biopsy and subsequent histopathological diagnosis. Colonoscopy also allows identification and endoscopic removal of polyps and adenomas.¹

In 2002, a pilot program was undertaken in Australia to test the feasibility, acceptability, and cost-effectiveness of national colorectal cancer screening. The success of this pilot program led to the Australian Government implementing:

Phase 1 of the NBCSP, which commenced in August 2006 to screen Australians of the target ages of 55 and 65 years.
Phase 2 commenced in July 2008 and screened Australians of the target ages of 50, 55 and 65 years.
Phase 3 commenced in July 2013 and screened Australians of the target ages of 50, 55, 60 and 65 years.
Phase 4 of the NBCSP commenced on 1 January 2015; in this phase the program is being gradually rolled-out over 5 years to achieve biennial screening for Australians aged 50–74 years.⁴

For a comparison with the broader Australian community see the NCCI 'Colonoscopy'.

Current status

In 2017, 6,852 Aboriginal and Torres Strait Islander people in the target age range provided a valid screening test of these, 800 (11.7%) Aboriginal and Torres Strait Islander people produced a positive FOBT screening, which was higher compared to the national screening positive rate of 7.9%.¹

Colonoscopy follow-up after a positive colorectal screening test

In 2017, 51.0% of Aboriginal and Torres Strait Islander people who returned a positive (abnormal) result from a correctly completed FOBT screening kit had a follow-up colonoscopy recorded within 360 days.¹

Time between positive screening test and diagnostic assessment

In 2017, the median time between a positive screening result and a diagnostic assessment was longer for Aboriginal and Torres Strait Islander people 70 days compared to the National median time of 52 days.¹

Trends

Colonoscopy follow-up after a positive colorectal screening test

From 2014 to 2017, colonoscopy follow-up rates within 360 days decreased among Aboriginal and Torres Strait Islander people from 58.5% to 51.0%.^1,6-8

Changes in the reporting process for follow-up colonoscopies, as well as changes in diagnostic assessment pathway practices between years, may be factors contributing to this observed decrease.¹ It should also be noted that this indicator relies on information being reported to the Program Register; however, this is not mandatory, leading to incomplete data. It should also be noted that not all participants with a positive screen will necessarily undergo diagnostic assessment.

Time between positive colorectal screening test and diagnostic assessment

From 2014 to 2017, the median time between a positive screen for colorectal cancer and diagnostic assessment for Aboriginal and Torres Strait Islander people has fluctuated between 64 days (2015) and 83 days (2014). Nonetheless, a generally decreasing trend is indicated with the median time to assessment being 70 days in 2017.^1,6-8

Addressing barriers to screening

In 2016-2017, about 21% of eligible Aboriginal and Torres Strait Islander people (aged 50 to 74 years) participated in the NBCSP compared to 43% of the broader Australian community.¹ To increase Aboriginal and Torres Strait Islander participation rates, The Australian Government Department of Health and Menzies School of Health Research launched a National Pilot program, the National Indigenous Bowel Screening Program.² This program is designed to encourage participation in the program by providing alternative pathways for Aboriginal and Torres Strait Islander peoples to receive a NBCSP, with the aim to detect early bowel changes to save lives.²

About the data

Follow-up after a positive FOBT screening test

This measure shows the proportion of the eligible invited population returning a positive (abnormal) result from a correctly completed FOBT screening test, who had a follow-up diagnostic assessment (colonoscopy).

Numerator: Number of persons who had a follow-up colonoscopy within 360 days.

Denominator: Number of persons who had a positive FOBT result in the defined 12-month period.

Median time

This measure shows the median time between a positive NBCSP screening test and a follow-up diagnostic assessment. For 2017 data, the positive screening test occurred between 1 January 2017 and 31 December 2017, and the follow-up diagnostic assessment was up to 31 December 2018.

Median time to follow-up assessment data was first reported in 2016, following publication of NBCSP performance indicators in 2014.1 Thus, to allow a trend comparison over time, these new indicator specifications were applied retrospectively to earlier years of program data.

Data sources

Australian Institute of Health and Welfare 2019.National Bowel Cancer Screening Program: monitoring report 2019.Cat. no. CAN 125. Canberra: AIHW.

Australian Institute of Health and Welfare 2018.National Bowel Cancer Screening Program: monitoring report 2018.Cat. no. CAN 112. Canberra: AIHW.

Australian Institute of Health and Welfare 2017.National Bowel Cancer Screening Program: monitoring report 2017.Cat. no. CAN 103. Canberra: AIHW.

Australian Institute of Health and Welfare 2016.National Bowel Cancer Screening Program: monitoring report 2016.Cat. no. CAN 97. Canberra: AIHW.

Data caveats

The National Bowel Cancer Screening Program is being implemented in a phased approach. National screening of Australians aged 60-64 years did not commence until Phase 3 was implemented in 2013, and screening of 70-74-year old commenced with the roll-out of Phase 4 in 2015 which incorporates biennial screening.⁴

As reporting of colonoscopies to the NBCSP is not mandatory, there is an unknown degree of under-reporting that may affect the data. These data are based on information recorded in the Program Register only.

References

Activity in this area

Data:

Australian Institute of Health and Welfare. AIHW Bowel cancer screening publications: Accessed February 2020; https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/cancer/reports

Policy:

Australian Government Department of Health. National Bowel Cancer Screening Program Phase Four (2015-2020) Policy Framework. Accessed February 2020; http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/program-frameworks-and-strategies

The National Indigenous Bowel Screening Program: Accessed February 2020; https://www.indigenousbowelscreen.com.au/

Cancer Australia. National Aboriginal and Torres Strait Islander Cancer Framework. 2015 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/overlay-context=affected-cancer/aboriginal-and-torres-strait-islander-people/national-aboriginal-and-torres-strait-islander-cancer-framework

Cancer Australia. Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer. 2018 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/optimal-care-pathway-aboriginal-and-torres-strait-islander-people-cancer

References

1. Australian Institute of Health and Welfare 2019.National Bowel Cancer Screening Program: monitoring report 2019.Cat. no. CAN 125. Canberra: AIHW.

2.The National Indigenous Bowel Screening Program: Accessed February 2020; https://www.indigenousbowelscreen.com.au/

3. Australian Institute of Health and Welfare 2019.Cancer in Australia 2019.Cat. no. CAN 123. Canberra: AIHW.

4. Australian Institute of Health and Welfare 2014.Analysis of bowel cancer outcomes for the National Bowel Cancer Screening Program. Canberra: AIHW.

5. Australian Government Department of Health 2017.National Bowel Cancer Screening Program Phase Four (2015-2020) Policy Framework. Version 0.8. Canberra: Australian Government Department of Health.

6. Australian Institute of Health and Welfare 2016.National Bowel Cancer Screening Program: monitoring report 2016.Cat. no. CAN 97. Canberra: AIHW.

7. Australian Institute of Health and Welfare 2017.National Bowel Cancer Screening Program: monitoring report 2017.Cat. no. CAN 103. Canberra: AIHW.

8. Australian Institute of Health and Welfare 2018.National Bowel Cancer Screening Program: monitoring report 2018.Cat. no. CAN 112. Canberra: AIHW.

9. Australian Institute of Health and Welfare 2018.Analysis of bowel cancer outcomes for the National Bowel Cancer Screening Program 2018.Cat. no. CAN 113. Canberra: AIHW.

Summary

The time between a positive screen for colorectal cancer and diagnostic assessment for Aboriginal and Torres Strait Islander people is improving over timeIn 2017, the median time between a positive FOBT screen and a colonoscopy assessment for Aboriginal and Torres Strait Islander people was 70 days, compared to 83 days in 2014. 

Revision Type

Major

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1.0.0

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Data

Summary

The time between a positive screen for colorectal cancer and diagnostic assessment for Aboriginal and Torres Strait Islander people is improving over time