Colorectal screening rate - participation | National Cancer Control Indicators

Published

24 Dec, 2019

Participation by the target population in colorectal screening is an important aspect of the prevention and early detection of colorectal cancer. Australia commenced an organised program of colorectal (bowel) cancer population screening in 2006. Indicators of the performance of this program, the National Bowel Cancer Screening Program (NBCSP), include the proportion of the eligible population who were invited and who returned a completed a faecal occult blood test (FOBT) kit for analysis.^{1, 2} A high participation rate is necessary for the NBCSP to achieve its major objective of reducing colorectal cancer incidence, morbidity and mortality.^{1, 2}

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Notes

• Data sourced from AIHW National cancer screening programs participation data and National Bowel Cancer Screening Program: monitoring reports.
• Data for 2007–2008 to 2012–2013 include age groups 50-54, 55-59 and 65-69; data for 2013–2014 also include age group 60-64; data for 2014–2015 to 2017–2018 also include age group 70–74.
• Rates are not age-standardised.

Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis over a 2-year period, 2007–2008 to 2017–2018
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Notes

• Data sourced from AIHW National cancer screening programs participation data and National Bowel Cancer Screening Program: monitoring reports.
• Data for 2007–2008 to 2012–2013 include age groups 50-54, 55-59 and 65-69; data for 2013–2014 also include age group 60-64; data for 2014–2015 to 2017–2018 also include age group 70–74.
• Rates are not age-standardised.

Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis in a 2-year period, by age group
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Notes

• Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
• Remoteness areas were allocated based on the Australian Statistical Geography Standard (ASGS) 2011.
• Rates are not age-standardised.

Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis, by remoteness area
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Notes

• Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
• Invitees were allocated to a socioeconomic group using their residential postcode according to the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage. For 2017 data the 2016 IRSD was used; for 2016, 2015, and 2014 data the 2011 IRSD was used.
• Rates are not age-standardised.

Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis, by socioeconomic status

About this measure

Australia has one of the highest rates of colorectal cancer in the world, and it is projected to be the third most commonly diagnosed cancer recorded in Australia in 2019 (after breast cancer and prostate cancer).^{3, 4} It is anticipated that in 2019, 16,398 persons will be diagnosed with colorectal cancer and that this cancer will cause 5,597 deaths.¹ It is also estimated that colorectal cancer will remain the second leading cause of cancer death in Australia (after lung cancer).³

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.^{2, 5} 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.^{2, 6}

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.⁵

Consistent with this move to biennial screening, the most recent available participation data are for a 2-year period.¹ Data relating to the use of FOBT kits through health clinics and other organisations on a user pays basis are not readily available. Whilst the impact of these on NBCSP participation is unknown, it has been noted that some non-participants in the NBCSP reported that they had ‘already had other bowel tests’.⁶

Current status

In the 2-year period 2017-2018, 42.4% of the eligible population (i.e. those invited to participate) returned a completed faecal occult blood test (FOBT) kit for analysis. Participation was higher among females (44.5%) than among males (40.2%) and increased with increasing age of male and female invitees.²

Aboriginal and Torres Strait Islander peoples

Data on participation by Indigenous status are not available, as this status is not known when an eligible person is invited to participate. (Indigenous status is determined via self-identification once a completed FOBT is returned for analysis.) However, by comparing self-identification rates of participants with self-identification rates in the 2016 Census, it was estimated that the participation rate for Indigenous Australians aged 50–74 who were invited in 2016–2017 was 21.0%, compared with an estimated participation rate for non-Indigenous Australians of 43.3%.²

Remoteness and socioeconomic status (SES)

Participation data by remoteness and socioeconomic status are available for all persons (not disaggregated by sex) for the period 2016–2017. The participation rate varied by remoteness, with the lowest participation rate occurring in Very Remote areas (27.5%) and the highest participation rate occurring in Inner Regional areas (44.5%).²

The participation rate also varied by socioeconomic status, although not to the extent observed for remoteness. In 2016–2017, the participation rate ranged from 39.1% for people living in the lowest socioeconomic status areas (SES 1) to 42.9% for people living in the highest socioeconomic status areas (SES 5).²

Comparable international data for participation in colorectal cancer screening are not available, due to differences in screening processes and target populations.

Trends

From 2007–2008 to 2012–2013, the participation rate decreased from 44.0% to 36.1%, but has since increased to 42.4% in 2017–2018. Similar participation rate trends were observed for males and females. Reasons for the recent increase in the participation rate include a growing proportion of participants that have previously participated in the NBCSP (i.e. re-invitees are known to participate at a higher rate, than those that have not previously participated), and higher participation rates among persons aged 70-74 years.²

From 2007–2008 to 2012–2013, participation rates generally decreased for most age groups. From 2012–2013 onwards, participation rates plateaued and since 2015-2016, have increased across all age groups. As previously noted, this is due to the increasing proportion of re-invitees participating in the program.

Remoteness and socioeconomic status (SES)

Trend data for participation by remoteness and by socioeconomic status are available from 2013–2014 to 2016–2017. Over these periods, the participation rate in each remoteness area and socioeconomic status area has increased .^{2, 7-9}

Colorectal cancer control in Australia

Since the initial trial of national cancer control screening through the pilot program and subsequent implementation of the NBCSP, improvements have been observed in mortality and survival rates. The age-standardised colorectal cancer mortality rate has decreased from 24.7 deaths per 100,000 in 2002 to 18.7 deaths per 100,000 in 2016, and 5-year relative survival has increased from 62.9% in 2001–2005 to 69.9% in 2011–2015.⁴ It has also been shown that among persons aged 50–74 years in the period 2006–2010, colorectal cancer and mortality rates were significantly lower among NBSCP invitees (i.e. those turning 50, 55 or 65 during that time) than among non-invitees.⁶

The NCCI measures Capture of stage data and Distribution of cancer stage present national data for Registry-Derived stage (RD-Stage) at diagnosis for the top 5 cancers by incidence in 2011. These data show that people aged 50 years and over had a higher proportion of early stage colorectal cancers at diagnosis (stage 1 and stage 2) than those aged less than 50 years. RD-stage data collection in subsequent years will provide us with more detailed evidence regarding the impact of the NBSCP on early detection of colorectal cancer in the target age range.

About the data

This measure shows the proportions of eligible persons who were invited to participate in the NBCSP and who returned a completed FOBT screening kit for analysis.

Numerator: Number of eligible persons invited in a 2-year period who returned a completed FOBT screening kit for analysis within that period or by 30 June the following year.

Denominator: Number of eligible persons who were invited to return a FOBT screening kit for analysis in a 2-year period.

Methodology

Remoteness

Participants were allocated to a remoteness area using the postcode supplied at the time of screening, using the Australian Statistical Geography Standard (ASGS) 2011.

Socioeconomic status

Participants were allocated to a socioeconomic group using their residential postcode according to the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage (IRSD). For 2017 data the 2016 IRSD was used; for 2016, 2015, and 2014 data the 2011 IRSD was used.

Data sources

Australian Institute of Health and Welfare 2019. National cancer screening programs participation data. Cat. no. CAN 114. Canberra: AIHW. Accessed: 05 December 2019; https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screeni....

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 years old commenced with the roll-out of Phase 4 in 2015 which incorporates biennial screening.

Data for participation rates are available to 2017–2018 whereas participation rates by remoteness area and SES are available to 2016–2017.

References

Activity in this area
Data:

Australian Institute of Health and Welfare. AIHW cancer screening publications: Accessed December 2019; https://www.aihw.gov.au/reports-statistics/health-welfare-services/cance...

Social Health Atlases of Australia: Population Health areas - National Bowel Cancer Screening Program 2016/17: Accessed December 2019; http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atl...

Policy:

Australian Government Department of Health. National Bowel Cancer Screening Program Phase Four (2015 – 2020) Policy Framework. Accessed December 2019; http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Cont... strategies

References

1. Australian Institute of Health and Welfare 2019. National cancer screening programs participation data. Cat. no. CAN 114. Canberra: AIHW. Accessed: 05 December 2019; https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screeni....

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

3. Australian Institute of Health and Welfare 2019. Cancer data in Australia. Cat. no. CAN 122. Canberra: AIHW. Accessed: 6 December 2019; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia.

4. Ferlay J, Ervik M, Lam F, et al. 2018. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Accessed: 05 December 2019; http://gco.iarc.fr/today.

5. Australian Government Department of Health 2019. National Bowel Cancer Screening Program. Canberra: Australian Government Department of Health. Accessed: 06 December 2019; http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Cont....

6. 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.

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

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

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

Summary

Over 40% of invited Australians participated in the National Bowel Cancer Screening ProgramIn 2017-2018, 42.4% of the eligible population participated in the National Bowel Cancer Screening Program in response to an invitation to screen.

Participation rates were lowest among people living in Very Remote areasIn 2016–2017, the colorectal cancer screening participation rate among eligible persons living in Very Remote areas was 27.5%.

Colorectal cancer screening participation rates vary by sexIn 2017-2018, the colorectal cancer screening participation rate was lower among males (40.2%) than among females (44.5%).

Colorectal cancer screening participation rates in recent years have been increasingFrom 2012-2013 to 2017-2018, the colorectal cancer screening participation rate increased from 36.1% to 42.4%.

Revision Type

Minor

Version Number

3.0

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Data

Summary

Over 40% of invited Australians participated in the National Bowel Cancer Screening Program

Participation rates were lowest among people living in Very Remote areas

Colorectal cancer screening participation rates vary by sex

Colorectal cancer screening participation rates in recent years have been increasing

Related features

Relative survival by stage at diagnosis 2011–2016, a snapshot in time

NCCI – About the Data