In this episode of PodMD, experienced Gastroenterologist and Hepatologist Dr Matt Kitson will be discussing the topic of bowel cancer screening. We discuss about bowel cancer screening in Australia, uptake of the National Bowel Cancer Screening Program, how should people with a higher than average risk for bowel cancer be screened and more.
- Transcript
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMD studio Dr Matt Kitson
Dr Matt Kitson is an experienced Gastroenterologist and Hepatologist providing care in the Eastern and Southeastern suburbs of Melbourne, and also in Gippsland.
Matt studied Medicine at the University of Queensland, graduating with Honours in 2001. After initially training at the Princess Alexandra Hospital in Brisbane he moved to London, working at the Royal Free and Royal London Hospitals, and then returned to Australia to complete Gastroenterology training at the Alfred and St Vincent’s Hospitals, obtaining his FRACP in 2011. He was awarded a PhD by Monash University in 2015 on his thesis which evaluated Vitamin D status in liver disease.
Today, we’ll be discussing the topic of bowel cancer screening.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.Matt, thanks for talking with us on PodMD today.
Matt: Thank you for having me.
Question 1
The topic of today’s discussion is bowel cancer screening. Matt, can you give us a brief overview about bowel cancer screening?Matt: Very happy to. My first point really is, I guess the main take home message in that in bowel cancer screening, 45 is the new 50. So the aim of bowel cancer screening is not only to detect cancer early when it’s curable, but also to prevent bowel cancer via the detection and removal of polyps, which are precursor lesions in the colon. In Australia bowel cancer screening is stool-based using immunochemical faecal occult blood testing or otherwise known as faecal immunochemical testing, and this is for asymptomatic people who are at average risk of bowel cancer and it’s done every two years. The thing that has recently changed is that bowel cancer screening via the national bowel cancer screening program is now available for those aged 45 and above. However, this is an opt-in process for people aged between 45 and 49 and they need to be proactive in requesting a kit via the national bowel cancer screening program. The alternative is that medical practitioners can request stool-based kits in bulk via the national bowel cancer screening program and give them to patients aged 40 and above.
Question 2
Matt, can you give us an overview of bowel cancer in Australia?Matt: So, the national bowel cancer screening program was completely rolled out in 2019, and it was originally for those aged between 50 and 74, with kit sent out every two years, and this has now expanded to include people aged 45 to 49, although as mentioned, they need to be proactive in requesting kits. Only about 40% of people who are sent kits actually do the test and return it, according to the most recent data that we have from 2022, and unfortunately this is slowly declining from a peak uptake of 44%. About 6% of people who return the tests have a positive test, and in those who have a positive test that go on to have a colonoscopy, about 4% of people have bowel cancer diagnosed. My estimation that probably about 50% of people who have a colonoscopy with a positive faecal occult blood test have polyps, which can be removed and have potentially prevented bowel cancer. Another important point is that only about 13% of people who have a positive faecal occult blood test actually have a colonoscopy within 30 days, and that number definitely needs to improve.
Question 3
How should people with a higher than average risk for bowel cancer be screened?/strong>Matt: That’s a very good question. So with bowel cancer screening, this is for asymptomatic people, I put people into two risk categories – those who are average risk and those who are above average risk. People who are average risk are people who are asymptomatic, aged 45 and above, who have either no family history of bowel cancer at all, or have a family history of bowel cancer in a first-degree relative older than age 35, and also who have no personal history of colorectal cancer, adenomas or inflammatory bowel disease. So those are the people who are at average risk. People who are above average risk have a history, family history of bowel cancer in a first degree, relative age less than 55 or a family history in two first degree relatives of any age or a family history of three or more first degree or second degree relatives. These people, because they are at above average risk of bowel cancer, need colonoscopy based screening rather than stool based screening, and this should occur from age 45 and above. And if there is a family history of bowel cancer at a younger age than colonoscopy based screening may need to occur from a younger age than 45.
Question 4
Matt, are there any other methods for bowel screening apart from FOBT and colonoscopy?Matt: Recently in the United States, a blood test called SHIELD has been approved and this detects DNA shed by tumours. Unfortunately, it’s not as accurate as we’d like, it’s only got an 87% detection rate for bowel cancer, which means it’s missing 13% of bowel cancer, which is not a great figure and it also can’t detect adenomatous, polyps or other polyps called sessile serrated lesions. But this is the first test blood test that we’ve seen and then there will be new developments down the track.
Concluding Question
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on bowel cancer screening?Matt: So my first take home point is that bowel cancer is preventable via the detection of polyps through screening and also the cancers that are detected via screening have a 40% lower mortality rate than cancers detected in in other ways in symptomatic people. My second point is that 45 is the new 50 for bowel cancer screening and the third point that I have is that the 40% uptake of screening rate needs to improve. And as medical practitioners, we have a responsibility to be involved in improving this rate and we should really be asking every patient above 45 whether they are participating in bowel cancer screening.
Thanks again for your time and the insights you’ve provided.
