A regional experience of the national bowel cancer screening program

Abstract

Background: The expansion of the National Bowel Cancer Screening Program (NBCSP) to biennial screening of people between 50 and 74 years of age is planned to occur by 2020. Although tertiary hospital outcomes from colonoscopy procedures are readily available, regional patient and service data on patient waiting times and outcomes, including adenoma and cancer detection rates and service quality, are less well documented. Method(s): Through a retrospective review, we describe and quantify patient demographics, waiting times from referral, standard colonoscopy benchmarking indicators, histopathological results and planned follow up for NBCSP for patients in a regional setting. The study hospital predominately services patients from inner regional and outer regional Australia and provides colonoscopy services to 110,000 people. A concurrent Cancer Prevention Project to further increase the uptake of screening and follow-up for patients who have a positive test (using an immunochemical faecal occult blood test, iFOBT) is being run by the study hospital. Data was cross-referenced between two databases within the hospital medical records and waitlist data, and an application to compare with central registry data held by Commonwealth Department of Health and Ageing has been submitted. Patients were included if they underwent a colonoscopy during the period January 2007 to December 2014. Result(s): Since January 2007, 180 patients have been followed-up with a colonoscopy as a result of a NBCSP positive iFOBT. Of these, approximately 70% of patients underwent colonoscopy within 30 -days of referral being received by the hospital, with an average waiting time of 28.55 days (SE +/- 1.4). Caecal intubation rates were above that recommended by US taskforce and withdrawal times were >= 6 minutes in over 80% of colonoscopy performed. Adenomata were detected in 83 out of 180 (46.1 %) patients, and 8 of 180 (4.44 %) patients showed adenocarcinoma on histology. Surveillance recommendations varied according to the relevant national guidelines with a trend towards repeating endoscopy sooner than recommended, following benchmark examination. Discussion(s): With the expansion of the NBCSP this study provides a practical insight into the outcomes of this national program outside a tertiary setting. Both adenoma and carcinoma detection rates in this study were much higher than national averages for NBCSP patients in the 2012-13 period where histopathology was confirmed (22% and 0.7 % respectively).1 Conclusion(s): The importance of appropriately-timed surveillance will also be vital to the ongoing sustainability of the national program to meet demand for these services.