Published 12 Oct, 2023

The National Bowel Cancer Screening Program (NBCSP) started in 2006 with the aim of reducing morbidity and mortality from bowel cancer by screening the eligible target population for early detection or prevention of the disease. Eligible Australians (those aged 50–74 years) are sent a free screening kit (immunochemical faecal occult blood test or immunochemical faecal occult blood test (iFOBT)) and are invited to screen every 2 years. Indicators of program performance include the proportion of the eligible population who were invited and who returned a completed screening kit for analysis. A high participation rate is necessary for the NBCSP to achieve its major objective of reducing colorectal cancer incidence, morbidity and mortality.1

    Charts
    • Notes
      • Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
      • Remoteness areas were allocated based on the Australian Statistical Geography Standard (ASGS). For 2018 -2020 data, the 2016 ASGS was used; whereas for earlier years, the 2011 ASGS was used.
      • Rates are not age-standardised.
      Table caption
      Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis over time, 2007-2008 to 2020-2021.
    • Notes
      • Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
      • Remoteness areas were allocated based on the Australian Statistical Geography Standard (ASGS). For 2018 -2020 data, the 2016 ASGS was used, whereas for earlier years, the 2011 ASGS was used.
      • Rates are not age-standardised.
      Table caption
      Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis, by age group over time, 2007-2008 to 2020-2021.
    • Notes
      • Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
      • Remoteness areas were allocated based on the Australian Statistical Geography Standard (ASGS). For 2018 -2020 data, the 2016 ASGS was used, whereas for earlier years, the 2011 ASGS was used.
      • Rates are not age-standardised.
      Table caption
      Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis, by remoteness area
    • Notes
      • Data sourced from AIHW National Bowel Cancer Screening Program: monitoring reports.
      • Remoteness areas were allocated based on the Australian Statistical Geography Standard (ASGS). For 2018 -2020 data, the 2016 ASGS was used, whereas for earlier years, the 2011 ASGS was used.
      • Rates are not age-standardised.
      Table caption
      Proportion of the eligible population invited who returned a completed FOBT screening kit for analysis, by socioeconomic status

    Australia has one of the highest rates of colorectal cancer in the world, with this cancer projected to be the fourth most common recorded cancer in Australia in 2022 with an age standardized rate of 48.9 per 100,000 people (after prostate cancer, breast cancer, and melanoma of the skin).2, 3

    Bowel cancer may be present for many years before a person shows symptoms, such as visible rectal bleeding, change in bowel habit, bowel obstruction or anaemia. Often, symptoms such as these are not present until the cancer has reached a relatively advanced stage. However, non-visible bleeding of the bowel may occur in the precancerous stages for some time. The relatively slow development of bowel cancer means that precancerous polyps and adenomas, and early-stage cancers, can potentially be screen-detected and effectively treated.1

    An immunochemical faecal occult blood test (iFOBT) is a common method of bowel cancer screening. An iFOBT is a non-invasive test that can detect microscopic amounts of blood in a sample from a bowel motion, which may indicate a bowel abnormality, such as an adenoma or cancer. FOBT screening reduces the risk of CRC mortality.4

    The two-yearly screening of the NBCSP was only fully rolled out from 2020 with phases in the preceding roll-out and target population shown below: 1

    Phase Start date End date Target ages (years)
    1 7 August 2006 30 June 2008 55 and 65
    2 1 July 2008 30 June 2011(a) 50, 55 and 65
    2(b) 1 July 2011 30 June 2013 50, 55 and 65
    3

    1 July 2013

    Ongoing 50, 55, 60 and 65
    4 1 January 2015   50, 55, 60, 65, 70 and 74
    4 1 January 2016   50, 55, 60, 64, 65, 70, 72 and 74
    4 1 January 2017   50, 54, 55, 58, 60, 64, 68, 70, 72 and 74
    4 1 January 2018   50, 54, 58, 60, 62, 64, 66, 68, 70, 72 and 74
    4 1 January 2019   50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72 and 74

     

     

     

     

     

     

     

     

    (a) Eligible birth dates, and thus invitations, ended on 31 December 2010.
    (b) Ongoing NBCSP funding commenced.

    Note: The eligible population for all Phase 2 and 3 start dates incorporates all those turning the target ages from 1 January of that year onwards.

    Participation in the NBCSP is measured over 2 calendar years to align with the 2-year recommended screening interval. Operationally, participation rates are calculated using an additional 6 months of data after the end of the 2-year invitation period, to allow time for all invitees to complete and return their screening kit.

     

    In the 2-year period 2020-2021, 40.9% of invited people participated in the NBCSP,1 which was lower than the 43.8% participation in the previous rolling 2-year period (2019–2020). Female invitees had a higher participation rate (42.8%) than male invitees (38.9%).1 Participation increased with age from 31.6% for people aged 50–54 years to 52.2% for people aged 70–74 years, and were higher in those who had previously participated in the program. The participation rate was higher for people receiving their second, third or later screening invitation (43%) than those receiving their first invitation (30%) in 2020-2021. Those who had participated in their previous invitation round had a re-participation rate of 81.0%, compared with 74.0% for those who had ever previously participated.1

    Remoteness and socioeconomic status (SES)

    For the period of 2020-2021, participation rates varied by remoteness, with the highest rate for people living in Inner regional areas (43.4%) and the lowest for people living in Very remote areas (25.3%).

    The participation rate also varied by socioeconomic status. People living in the highest socioeconomic areas had the highest participation rate (44.7%), whereas the lowest rate applied to those living in the lowest socioeconomic areas (36.6%).

    International

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

    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). For 2018, 2019 and 2020 data, the 2016 ASGS was used; for earlier years, the 2011 ASGS was used.

    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). Data from 2017 onwards used the 2016 IRSD; for earlier years the 2011 IRSD was used.  

    Data caveats

    The NBCSP program began in 2006, offering screening to people aged 55 and 65 years, and was subsequently expanded to include other ages. In 2014, the Australian Government announced that the program would be extended to offer free 2-yearly screening for all Australians aged 50–74 years. The extension was completed in 2020.1

    Monitoring reports before 2016 analysed participation differently from the indicator used in this report.

    To allow trends to be compared over time, the new participation indicator specifications have been applied retrospectively to earlier years of program data within the 2023 National Bowel Cancer Screening Report.1

    The performance indicators in the 2023 National Bowel Cancer Screening report1 use data collected for the NCSR (January 2020 to December 2023). However, this report also summarizes trends from 2007–2008 to 2020–2021 in program participation rate, diagnostic assessment rate, and time between positive screen and diagnostic assessment. These trends use data collected for the NBCSP Register as well as data collected for the NCSR.

    Data sources

    Australian Institute of Health and Welfare 2023. National Bowel Cancer Screening program monitoring report 2023. Cat. no. CAN 154. Canberra: AIHW. Accessed June 2023; https://www.aihw.gov.au/reports/cancer-screening/nbcsp-monitoring-2023/data

    Australian Institute of Health and Welfare 2023. Cancer screening programs: quarterly data. Cat. no. CAN 114. Canberra: AIHW. Accessed June 2023. https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/data

    Australian Institute of Health and Welfare 2022. National Bowel Cancer Screening Program: monitoring report 2022. Cat. no. CAN 148. Canberra: AIHW.

    Australian Institute of Health and Welfare 2021.National Bowel Cancer Screening Program: monitoring report 2021. Cat. no. CAN 139. Canberra: AIHW.

    Australian Institute of Health and Welfare 2020.National Bowel Cancer Screening Program: monitoring report 2020. Cat. no. CAN 133. Canberra: AIHW.

    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.

    1. Australian Institute of Health and Welfare 2023. National Bowel Cancer Screening program monitoring report 2023. Cat. no. CAN 154. Canberra: AIHW. Accessed June 2023; https://www.aihw.gov.au/reports/cancer-screening/nbcsp-monitoring-2023/summary
    2. Cancer Australia 2022. Bowel cancer statistics. Cancer Australia 2022. Accessed March 2023; https://www.canceraustralia.gov.au/cancer-types/bowel-cancer/statistics#:~:text=In%202020%2C%20bowel%20cancer%20was,2%2C847%20males%20and%202%2C507%20females
    3. Australian Institute of Health and Welfare 2022. Cancer Data in Australia. Cancer rankings data visualisation. Accessed March 2023; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-rankings-data-visualisation
    4. Hewitson P et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008 Jun;103(6):1541-9. doi: 10.1111/j.1572-0241.2008.01875.x.
    5. Australian Institute of Health and Welfare 2023. Cancer screening programs: quarterly data. Cat. no. CAN 114. Canberra: AIHW. Accessed May 23; https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/about
    6. Australian Institute of Health and Welfare 2022. Cancer Data in Australia. Cancer mortality by age visualisation. Accessed March 2023; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-mortality-by-age-visualisation
    7. Australian Institute of Health and Welfare 2022. Cancer Data in Australia. Cancer survival data visualisation. Accessed March 2023; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-survival-data-visualisation
    8. Australian Institute of Health and Welfare 2018. Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia. Cat. no. CAN 115. Canberra: AIHW. Accessed March 23; https://www.aihw.gov.au/reports/cancer-screening/cancer-outcomes-screening-behaviour-programs/summary
    9. Australian Institute of Health and Welfare 2018. Analysis of bowel cancer outcomes for the National Bowel Cancer Screening Program. Cat. no. CAN 113. Canberra: AIHW. Accessed March 23; https://www.aihw.gov.au/reports/cancer-screening/analysis-of-bowel-cancer-outcomes-nbcsp-2018/summary
    10. Cole SR, Tucker GR, Osborne JM, et al. Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust. 2013 Apr 1;198(6):327-30. doi: 10.5694/mja12.11357.
    11. Lew JB, St John DJB, Xu XM, et al. Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study. Lancet Public Health 2:e331–e340.
    12. Australian Government of Health and Aged Care. Final report on the National Indigenous Bowel Screening Pilot. Accessed March 2023; https://www.health.gov.au/resources/publications/final-report-on-the-national-indigenous-bowel-screening-pilot?language=en

    Summary

    More than 40% of invited Australians are participating in the National Bowel Cancer Screening Program (NBCSP)

    A total of 2,490,137 people participated in the 2-year period for 2020–21 with the rate at 40.9%.

    Colorectal cancer screening participation rates are higher in females

    In 2020-2021, female invitees had a higher participation rate (42.8%) than males (38.9%).

    Participation rates increase with older age

    In 2020-2021, the participation rate increased with increases in invitation age group, from 31.6% for people aged 50–54 years to 52.2% for people aged 70–74 years.

    Participation rates are lowest among people living in Very remote areas

    The participation rate was highest for people living in Inner regional areas (43.4%) and lowest for people living in Very remote areas (25.3%) in the period 2020-2021.

    Higher participation rates are found in areas of higher socioeconomic status

    People living in the highest socioeconomic areas had the highest participation rate (44.7%) whereas the lowest participation applied to those living in the lowest socioeconomic areas (36.6%) in the period 2020-2021.