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Bowel Cancer

Early Detection, Screening and Surveillance for Bowel Cancer

The third edition of this booklet has been produced as an update to alert health professionals to new information published on the early detection, screening and surveillance for bowel cancer. It builds on the second edition, which was published by the Australian Gastroenterology Institute and the Australian Cancer Society in 1994.

Compelling data from randomised controlled trials reaching level 1 evidence is now available to support screening for bowel cancer. In addition, there have been major advances in knowledge about the genetic basis of inherited predisposition to bowel cancer leading to availability of predictive genetic testing for many families.

These developments have been recognised by the Australian Health Technology & Advisory Committee (AHTAC), advising the Federal Minister of Health. The Digestive Health Foundation (DHF) supports the recommendations of the AHTAC Committee and has prepared this booklet to assist clinicians and health professionals as the Australian community develops and implements plans for the early detection, screening and surveillance for bowel cancer. Nevertheless, recommendations contained in this document may change as more information becomes available, particularly with respect to improved faecal occult blood detection techniques and the benefits of endoscopic screening

It should be recognised that many screening tests are less precise than the diagnostic tests used to investigate patients with symptoms. The objective of screening is to apply a test to people who are as yet asymptomatic, to classify them as being more likely or less likely to have that disease. To have maximal impact on disease morbidity and mortality in the community, the test needs to be acceptable to a substantial proportion of the population. A screening test therefore must be safe, relatively simple and preferably inexpensive. Those with positive screening tests should have follow-up diagnostic investigation.