Bowel screening programme will save lives
The clinical director of the National Bowel Screening Programme, Susan Parry, responds to criticism that the programme is too little, too late.
This week the free National Bowel Screening Programme launched at the first two district health boards, Hutt Valley and Wairarapa – a major milestone for the New Zealand health system.
It is important that both the health sector and public have access to accurate information on this life-saving initiative.
The programme will be implemented progressively over the next three years. We want to make this free screening programme available as quickly as possible to those most at risk, while ensuring safety and quality.
All eligible people aged 60 to 74 will access the same screening experience – getting the same free screening test to complete at home. Their pathway for any further investigations or treatment will be the same regardless of geographical location. There are no ‘‘versions’’ of this screening programme.
About 3000 New Zealanders are diagnosed with bowel cancer each year and more than 1200 die from it.
Bowel screening can help detect cancer at an early stage when more easily treated. It is anticipated, once fully rolled out, 500-700 cancers a year will be detected.
Bowel cancer incidence increases with age; 94 per cent of cases occur in those aged 50 or over and 82 per cent in those 60 and over. The number of new cases of bowel cancer each year is projected to increase by 15 per cent for men and 19 per cent for women due to population increases (when adjusted for population change there is a slight downward trend).
Screening programmes are complex. The programme parameters have been set so the benefits of screening outweigh the harms for the whole population. Targeting those most at risk of having bowel cancer uses available resources for the best possible outcomes for as many people as possible. Referring people for colonoscopy who’ve had a positive test through screening should not create such demand that we delay access for others who may have symptoms.
One of the National Bowel Screening Programme’s international advisors, United Kingdom based Professor Stephen Halloran, notes that, ‘‘Your programme has the hallmark of quality, thorough research, detailed planning, meticulous preparation and a focus on ease of access and equity for the population at most risk. Welldesigned programmes, like New Zealand’s, can grow in time to make the most of evidence and growing healthcare.’’
This programme is being invested in. Funding of $39.3 million was provided in Budget 2016, and a further $38.5 million in Budget 2017.
Also $19 million of additional funding for colonoscopy services has been provided to DHBs since 2013/14, to reduce waiting times and ensure that progress made on delivering colonoscopies is sustained.
When deciding on possible start dates for bowel screening in each DHB, careful consideration was given to a range of factors, including information provided by the DHBs.
Concerns were raised by CDHB last year about the pressure on resources due to other major projects in 2018, and their ability to implement the programme by the original indicative start date of July 2018. This resulted in Canterbury’s start date moving to later in the 2018/19 financial year allowing the DHB more time for a safe effective roll-out of the programme.
It is important not to confuse population level screening for bowel cancer with investigation of individuals who have bowel symptoms. Bowel screening is for people who do not have bowel symptoms. Those with symptoms should talk to their GP, and if they meet the referral criteria, be sent for investigation.
There have been recent concerns about treatment access for people aged under 50. People with rectal bleeding under 50 with a normal haemoglobin level (i.e. who don’t have iron deficiency anaemia) don’t fit the national direct access colonoscopy referral criteria. However the criteria recommends considering referral for specialist assessment or flexible sigmoidoscopy. To address this concern some hospitals offer rectal bleeding clinics where flexible sigmoidoscopy can be performed if indicated. Age is not a barrier to referral or treatment for those with symptoms who meet the criteria.
Those considered at higher risk of developing bowel cancer due to a family history, can be referred by their GP to a dedicated service -–the Familial Gastrointestinal Cancer Service.
I think everyone is in agreement that bowel screening is needed in New Zealand, and it needs to start now.
This programme will save lives. I encourage those invited to take part in the National Bowel Screening Programme to do the test.
Dr Susan Parry is an associate professor, gastroenterologist and clinical director of the Ministry of Health’s National Bowel Screening Programme. For further information on the National Bowel Screening programme go to bowelscreening.health.govt.nz.