Patients deserve results of screening process
WE agree with Brian Cox (ODTletters,
6.9.17), the national bowel screening programme is creating a disservice to participants. Reporting test results only as positive or negative, rather than the actual measure of blood detected, is designed to fit with a cutoff level set to manage access to further colonoscopy investigation within currently available resources. Bowel screening programmes elsewhere use a lower cutoff level. Will participants with patient portals that disclose their other full test results have this particular information blocked?
Everyone is entitled to know the full results of any health tests undertaken. They can use Rule 6 of the Health Information Privacy Code to obtain this from whichever agency is collecting and holding that information for the programme. Surely, the best process is to provide the actual result to the patient and their doctor in the first place so informed decisions can be made about any further care that may be considered.
Barbara Holland and Barbara Robson
Coconveners Federation of Women’s Health
Councils Aotearoa
Greymouth [Dr Susan Parry, clinical director — national bowel screening programme, Ministry of Health, replies: ‘‘Screening programmes are complex and need to balance the benefits and harms for the population as a whole. This includes using available resources to get the best possible outcomes for as many people as possible.
‘‘One of the requirements of a bowel screening programme is that further investigation (usually a colonoscopy) can be provided to participants in a timely manner. It would be unethical to offer screening, and then not be able to ensure that followup is available for those who return a positive test.
‘‘The screening test can detect tiny amounts of blood in a bowel motion, which can be a sign that there is a problem with the bowel. It is important to note that small amounts of blood are most commonly caused by minor conditions such as haemorrhoids.
‘‘The Bowel Screening Pilot found there was a strong link between the amount of blood detected in a participant’s screening test and the chance of that person having a cancer or an advanced adenoma (potentially precancerous growth) in their bowel. During the Pilot, 86% of the colonoscopies performed after a result that was below the threshold which has been chosen for the national programme did not find a cancer or an advanced adenoma. The threshold for bowel screening programmes is country specific, based on the type of immunochemical test used and pilot data.
‘‘Test results are reported by the laboratory as either positive or negative. This is in line with what is done by all centrally managed bowel screening programmes that use faecal immunochemical tests. New
Zealand’s decision to follow international practice has been endorsed by the National Screening Advisory Committee.
‘‘Bowel screening is for people who have no bowel symptoms and are considered at average risk of developing bowel cancer. Anyone who has bowel symptoms which concern them should talk to their doctor.’’]