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Bowel cancer screening programme under threat in Australia
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Australia’s bill for bowel cancer is set to hit AU$1 billion this year, but the federal government has committed no ongoing funding to the Bowel Cancer Screening Program after June 30, 2011. Benefits of this programme have been well established for about 15 years, and, fully implemented, up to 30 deaths per week could be prevented. Bowel cancer is the second biggest cause of cancer death in Australia. However, since 2006 only a piecemeal programme has been delivered, on the basis of federal government affordability and poor prioritisation. Until the end of 2011, people aged only 50, 55, and 65 years will be screened rather than the recommended biennial testing of all people older than 50 years. Plans for screening beyond 2011 are uncertain. Fully implemented, the programme could cost up to $140 million per year, but savings on increasingly expensive treatment for advanced disease would offset costs. Cancer Council Australia’s Chief Executive Officer, Ian Olver, explains: “we’re starting to see tens of thousands of dollars a year per patient to get use of new drugs like bevacizumab with chemotherapy for metastatic disease”. Which makes, he says, the economic balance of funding screening a bit more persuasive. The cost of Australia’s successful BreastScreen programme is $150 million per year, with mortality benefits that are no greater than those that would be achieved with a full programme for bowel screening. Similarly, the National Cervical Screening Program has been highly effective, having reduced cervical cancer deaths to 200–300 per year, a figure that will reduce further now that the HPV vaccine has been introduced. The breast and cervical population screening have been in place for 15 and 19 years, respectively. Olver believes that were the profile of bowel cancer higher than it is, like that of breast cancer, they would not be still waiting for the programme. Michael Jefford, a consultant medical www.thelancet.com/oncology Vol 12 February 2011
oncologist at Peter MacCallum Cancer Centre, agrees. “Bowel cancer has been neglected in terms of screening and advocacy, which is really unfortunate”, he told The Lancet Oncology. “There are more people in Australia with bowel cancer than women with breast cancer, but people don’t know that.” Low awareness is shown by the bowel programme’s uptake rates—37% in men and 43% in women. By comparison, the 3-year participation rate for the cervical screening programme is more than 70% and BreastScreen has an uptake of 54%. “If the government announced the continuation and indeed completion of the programme, then they would be able to advertise it coherently and get behind it with public information kits”, explains Olver. Essentially, increased investment could improve awareness and, thus, participation rates. Such low awareness of bowel cancer is thought to be a factor in the absence of urgency by the federal government to commit to ongoing funding. “It’s much easier to withdraw or underfund something when people don’t know about it”, says Jefford. Finlay Macrae, Head of Colorectal Medicine and Genetics at The Royal Melbourne Hospital, points out that further delays in funding uncertainty have the potential to undermine existing programme structures. “The whole infrastructure—the manpower— of the programme is seriously under threat because of lack of guarantee of funding.” The best outcome now would be for the federal government to announce an implementation plan in the 2011–12 budget. “What we’d like to see”, says Olver, “is a plan over 2 or 3 years to fully implement it”. Anita Tang, Manager of Policy and Advocacy at Cancer Council New South Wales, says she is optimistic that a commitment will be given to rolling out the programme after a positive response to a parliamentary education session run in November last year. After the session, the Federal Health
James King-Holmes/Science Photo Library
Bowel cancer screening programme under threat in Australia
The future of the Australian bowel cancer screening programme is uncertain
Minister, Nicola Roxon, acknowledged in parliament that biennial screening for everyone older than 50 years was the ideal programme. In Australia, cancer funding for treatment and research, while never enough, fares better than does prevention and screening. “For the economic advantage of prevention or early detection, it is grossly underfunded for the benefit that it yields”, says Olver. Internationally, Australia is lagging behind with bowel screening. “It is astounding that the government has not guaranteed continued—if not increased—funding in the face of what is happening internationally,” says Macrae. By comparison, UK’s National Bowel Screening Programme achieved nationwide coverage by 2010, with a further £60 million to be invested over the next 4 years to introduce flexible signmoidoscopy into the agenda. “Screening programmes should have sustainable funding; they’re not pilot programmes that you can do for 2 or 3 years and abandon”, states Olver. “You should plan to complete the programme so that you take full advantage of early detection.” For now, Cancer Council and clinicians await the federal budget in May, with hope that the Australian Government can prioritise investment in a cost-effective programme that is proven to work and saves lives.
Tamara Barrett 123
Australia’s bill for bowel cancer is set to hit AU$1 billion this year, but the federal government has committed no ongoing funding to the Bowel Cancer Screening Program after June 30, 2011. Benefits of this programme have been well established for about 15 years, and, fully implemented, up to 30 deaths per week could be prevented. Bowel cancer is the second biggest cause of cancer death in Australia. However, since 2006 only a piecemeal programme has been delivered, on the basis of federal government affordability and poor prioritisation. Until the end of 2011, people aged only 50, 55, and 65 years will be screened rather than the recommended biennial testing of all people older than 50 years. Plans for screening beyond 2011 are uncertain. Fully implemented, the programme could cost up to $140 million per year, but savings on increasingly expensive treatment for advanced disease would offset costs. Cancer Council Australia’s Chief Executive Officer, Ian Olver, explains: “we’re starting to see tens of thousands of dollars a year per patient to get use of new drugs like bevacizumab with chemotherapy for metastatic disease”. Which makes, he says, the economic balance of funding screening a bit more persuasive. The cost of Australia’s successful BreastScreen programme is $150 million per year, with mortality benefits that are no greater than those that would be achieved with a full programme for bowel screening. Similarly, the National Cervical Screening Program has been highly effective, having reduced cervical cancer deaths to 200–300 per year, a figure that will reduce further now that the HPV vaccine has been introduced. The breast and cervical population screening have been in place for 15 and 19 years, respectively. Olver believes that were the profile of bowel cancer higher than it is, like that of breast cancer, they would not be still waiting for the programme. Michael Jefford, a consultant medical www.thelancet.com/oncology Vol 12 February 2011
oncologist at Peter MacCallum Cancer Centre, agrees. “Bowel cancer has been neglected in terms of screening and advocacy, which is really unfortunate”, he told The Lancet Oncology. “There are more people in Australia with bowel cancer than women with breast cancer, but people don’t know that.” Low awareness is shown by the bowel programme’s uptake rates—37% in men and 43% in women. By comparison, the 3-year participation rate for the cervical screening programme is more than 70% and BreastScreen has an uptake of 54%. “If the government announced the continuation and indeed completion of the programme, then they would be able to advertise it coherently and get behind it with public information kits”, explains Olver. Essentially, increased investment could improve awareness and, thus, participation rates. Such low awareness of bowel cancer is thought to be a factor in the absence of urgency by the federal government to commit to ongoing funding. “It’s much easier to withdraw or underfund something when people don’t know about it”, says Jefford. Finlay Macrae, Head of Colorectal Medicine and Genetics at The Royal Melbourne Hospital, points out that further delays in funding uncertainty have the potential to undermine existing programme structures. “The whole infrastructure—the manpower— of the programme is seriously under threat because of lack of guarantee of funding.” The best outcome now would be for the federal government to announce an implementation plan in the 2011–12 budget. “What we’d like to see”, says Olver, “is a plan over 2 or 3 years to fully implement it”. Anita Tang, Manager of Policy and Advocacy at Cancer Council New South Wales, says she is optimistic that a commitment will be given to rolling out the programme after a positive response to a parliamentary education session run in November last year. After the session, the Federal Health
James King-Holmes/Science Photo Library
Bowel cancer screening programme under threat in Australia
The future of the Australian bowel cancer screening programme is uncertain
Minister, Nicola Roxon, acknowledged in parliament that biennial screening for everyone older than 50 years was the ideal programme. In Australia, cancer funding for treatment and research, while never enough, fares better than does prevention and screening. “For the economic advantage of prevention or early detection, it is grossly underfunded for the benefit that it yields”, says Olver. Internationally, Australia is lagging behind with bowel screening. “It is astounding that the government has not guaranteed continued—if not increased—funding in the face of what is happening internationally,” says Macrae. By comparison, UK’s National Bowel Screening Programme achieved nationwide coverage by 2010, with a further £60 million to be invested over the next 4 years to introduce flexible signmoidoscopy into the agenda. “Screening programmes should have sustainable funding; they’re not pilot programmes that you can do for 2 or 3 years and abandon”, states Olver. “You should plan to complete the programme so that you take full advantage of early detection.” For now, Cancer Council and clinicians await the federal budget in May, with hope that the Australian Government can prioritise investment in a cost-effective programme that is proven to work and saves lives.
Tamara Barrett 123