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Optimising the expansion of the National Bowel Cancer Screening Program.

ABSTRACT: OBJECTIVES:To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact of the expansion scenarios on colonoscopy demand. DESIGN:MISCAN-Colon, a well established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50-year period, starting in 2006. The model parameters included rates of participation in screening and follow-up, rates of identification of cancerous and precancerous lesions, bowel cancer incidence, mortality and the outcomes of the NBCSP. Five implementation scenarios, based on biennial screening using an immunochemical faecal occult blood test, were developed and modelled. A sensitivity analysis that increased screening participation to 60% was also conducted. PARTICIPANTS:Australian residents aged 50 to 74 years. MAIN OUTCOME MEASURES:Comparison of the impact of five implementation scenarios on the number of bowel cancer deaths prevented and demand for colonoscopy. RESULTS:MISCAN-Colon calculated that in its current state, the NBCSP should prevent 35 169 bowel cancer deaths in the coming 40 years. Accelerating the expansion of the program to achieve biennial screening by 2020 would prevent more than 70 000 deaths. If complete implementation of biennial screening results in a corresponding increase in participation to 60%, the number of deaths prevented will increase across all scenarios. CONCLUSIONS:The findings strongly support the need for rapid implementation of the NBCSP. Compared with the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths (about 35 000) being prevented in the coming 40 years.

SUBMITTER: Cenin DR

PROVIDER: S-EPMC4412258 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Optimising the expansion of the National Bowel Cancer Screening Program.

Cenin Dayna R DR St John D James B DJ Ledger Melissa J N MJ Slevin Terry T Lansdorp-Vogelaar Iris I

The Medical journal of Australia 20141001 8

<h4>Objectives</h4>To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact of the expansion scenarios on colonoscopy demand.<h4>Design</h4>MISCAN-Colon, a well established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50-year period, startin ...[more]

PMID: 25332032

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Project description:BACKGROUND:The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of spending on effective interventions to increase adherence has not yet been quantified. OBJECTIVES:To estimate (i) reductions in CRC cases and deaths for 2020-2040 attributable to, and (ii) the threshold for cost-effective investment (TCEI) in, effective future interventions to improve participation in the NBCSP. METHODS:A comprehensive microsimulation model, Policy1-Bowel, was used to simulate CRC natural history and screening in Australia, considering currently reported NBCSP adherence rates, i.e. iFOBT participation (∼40%) and diagnostic colonoscopy assessment rates (∼70%). Australian residents aged 40-74 were modelled. We evaluated three scenarios: (1) diagnostic colonoscopy assessment increasing to 90%; (2) iFOBT screening participation increasing to 60% by 2020, 70% by 2030 with diagnostic assessment rates of 90%; and (3) iFOBT screening increasing to 90% by 2020 with diagnostic assessment rates of 90%. In each scenario, we estimated CRC incidence and mortality, colonoscopies, costs, and TCEI given indicative willingness-to-pay thresholds of AUD$10,000-$30,000/LYS. RESULTS:By 2040, age-standardised CRC incidence and mortality rates could be reduced from 46.2 and 13.5 per 100,000 persons, respectively, if current participation rates continued, to (1) 44.0 and 12.7, (2) 36.8 and 8.8, and (3) 31.9 and 6.5. In Scenario 2, 23,000 lives would be saved from 2020-2040 vs current participation rates. The estimated scenario-specific TCEI (Australian dollars or AUD$/year) to invest in interventions to increase participation, given a conservative willingness-to-pay threshold of AUD$10,000/LYS, was (1) AUD$14.9M, (2) AUD$72.0M, and (3) AUD$76.5M. CONCLUSION:Significant investment in evidence-based interventions could be used to improve NBCSP adherence and help realise the program's potential. Such interventions might include mass media campaigns to increase program participation, educational or awareness interventions for practitioners, and/or interventions resulting in improvements in referral pathways. Any set of interventions which achieves at least 70% iFOBT screening participation and a 90% diagnostic assessment rate while costing under AUD$72 million annually would be highly cost-effective (<AUD$10,000/LYS) and save 23,000 additional lives from 2020-2040.

Project description:Colorectal neoplasia causes bleeding, enabling detection using Faecal Occult Blood tests (FOBt). The National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) guaiac-based FOBt (gFOBt) kits contain six sample windows (or 'spots') and each kit returns either a positive, unclear or negative result. Test kits with five or six positive windows are termed 'abnormal' and the subject is referred for further investigation, usually colonoscopy. If 1-4 windows are positive, the result is initially 'unclear' and up to two further kits are submitted, further positivity leads to colonoscopy ('weak positive'). If no further blood is detected, the test is deemed 'normal' and subjects are tested again in 2 years' time. We studied the association between spot positivity % (SP%) and neoplasia.Subjects in the Southern Hub completing the first of two consecutive episodes between April 2009 and March 2011 were studied. Each episode included up to three kits and a maximum of 18 windows (spots). For each positivity combination, the percentage of positive spots out of the total number of spots completed by an individual in a single-screening episode was derived and named 'SP%'. Fifty-five combinations of SP can occur if the position of positive/negative spots on the same test card is ignored.The proportion of individuals for whom neoplasia was identified in Episode 2 was derived for each of the 55 spot combinations. In addition, the Episode 1 spot pattern was analysed for subjects with cancer detected in Episode 2.During Episode 2, 284,261 subjects completed gFOBT screening and colonoscopies were performed on 3891 (1.4%) subjects. At colonoscopy, cancer was detected in 7.4% (n=286) and a further 39.8% (n=1550) had adenomas. Cancer was detected in 21.3% of subjects with an abnormal first kit (five or six positive spots) and in 5.9% of those with a weak positive test result.The proportion of cancers detected was positively correlated with SP%, with an R(2) correlation (linear) of 0.89. As the SP% increased from 11 to 100%, so the colorectal cancer (CRC) detection rate increased from 4 to 25%. At the lower SP%s, from 11to 25%, the CRC risk was relatively static at ~4%. Above an SP% of 25%, every 10-percentage points increase in the SP%, was associated with an increase in cancer detection of 2.5%.This study demonstrated a strong correlation between SP% and cancer detection within the NHS BCSP. At the population level, subjects' cancer risk ranged from 4 to 25% and correlated with the gFOBt spot pattern.Some subjects with an SP% of 11% proceed to colonoscopy, whereas others with an SP% of 22% do not. Colonoscopy on patients with four positive spots in kit 1 (SP% 22%) would, we estimate, detect cancer in ~4% of cases and increase overall colonoscopy volume by 6%. This study also demonstrated how screening programme data could be used to guide its ongoing implementation and inform other programmes.

Project description:ObjectivesThis field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years.DesignAdjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation.SettingAustralia.ParticipantsAll Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019.InterventionsA multiwave national integrated media campaign to promote participation in the NBCSP.Main outcome measuresiFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants).ResultsThe rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign.ConclusionsThe campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.

Project description:OBJECTIVES AND DESIGN:This field experiment aimed to compare bowel cancer screening participation rates prior to, during and after a mass media campaign promoting screening, and the extent to which a higher intensity campaign in one state led to higher screening rates compared with another state that received lower intensity campaign exposure. INTERVENTION:An 8-week television-led mass media campaign was launched in selected regions of Australia in mid-2014 to promote Australia's National Bowel Cancer Screening Program (NBCSP) that posts out immunochemical faecal occult blood test (iFOBT) kits to the homes of age-eligible people. The campaign used paid 30-second television advertising in the entire state of Queensland but not at all in Western Australia. Other supportive campaign elements had national exposure, including print, 4-minute television advertorials, digital and online advertising. OUTCOME MEASURES:Monthly kit return and invite data from NBCSP (January 2012 to December 2014). Return rates were determined as completed kits returned for analysis out of the number of people invited to do the iFOBT test in the current and past 3 months in each state. RESULTS:Analyses adjusted for seasonality and the influence of other national campaigns. The number of kits returned for analysis increased in Queensland (adjusted rate ratio 20%, 95% CI 1.06% to 1.35%, p<0.01) during the months of the campaign and up to 2 months after broadcast, but only showed a tendency to increase in Western Australia (adjusted rate ratio 11%, 95% CI 0.99% to 1.24%, p=0.087). CONCLUSIONS:The higher intensity 8-week television-led campaign in Queensland increased the rate of kits returned for analysis in Queensland, whereas there were marginal effects for the low intensity campaign elements in Western Australia. The low levels of participation in Australia's NBCSP could be increased by national mass media campaigns, especially those led by higher intensity paid television advertising.

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Optimising the expansion of the National Bowel Cancer Screening Program.

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Optimising the expansion of the National Bowel Cancer Screening Program.

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