Screening Test

To Scott's wife, in private, the doctor confided that the gloomy prognosis of 12 to 18 months was actually an optimistic one _ in truth her husband would be lucky to live past six months.
As it turned out, luck was well and truly on Scott's side. Fifteen years on, he's still here.
But there are two things he remains acutely aware of. His cancer could very well have abruptly cut his life short at 52 _ bowel cancer is, after all, responsible for more deaths in Australia than any other cancer except lung cancer.
And many of the discomforts and unpleasantness he still endures today, such as a ``weakness'' that sends him to the toilet countless times a day, sometimes for hours at a time, could have been avoided.
Bowel cancer is most diagnosed cancer in Australia excluding non-melanoma skin cancers, and it is often lethal, claiming about 4700 lives each year. But when it's caught early enough, it is also highly treatable.
That is why the federal government's announcement in last year's budget that it would set aside $43.4 million through 2008 to launch a national bowel cancer screening program has been so highly anticipated.
Clinical trials, similar programs in countries such as Denmark and the UK, and the federally-funded Faecal Occult Blood Test-based pilot study completed last June in South Australia, Victoria and Queensland have all met with significant success.
Experts say at least 1000 lives will be saved each year once the program is fully rolled out. That's a conservative estimate, based on the results of the pilot study where about 45 per cent of those invited to participate in the screening actually did.
With education and adequate promotion that percentage will probably increase, meaning that 1500 or even 2000 lives could realistically be saved every year, says Graeme Young, professor of gastroenterology at Adelaide's Flinders University.
Put another way, people who are screened are 40 per cent less likely to die from bowel cancer than those who have not been screened.
Over the next two years nearly one million people will receive the faecal occult blood test (FOBT) in the mail. The test detects hidden amounts of blood in the stool, which could signify cancer. Five to 10 per cent of those who test positive on the screening are diagnosed with cancer, while another 30 per cent have benign tumours, and the rest are ``incidental'', says Professor Finlay Macrae, a gastroenterologist at the Royal Melbourne Hospital who is on both the federal and state advisory committees for the screening program.
Although the FOBT itself has been available for a long time, its use is less than optimal _ partly because patients and sometimes even doctors find the process of handing over stool samples embarrassing and unpleasant.
Part of the drawcard of the new system is that the testing kit is sent to your own home and the sample collected in privacy. The sample can then be placed in the container provided and posted to a pathology laboratory for analysis. The results are later sent to the patient and their GP.
Along with the convenience, the federal health department says the kits are also effective because of their simplicity. In the pilot study 92 per cent of patients correctly completed the test kits.
But introducing another population-wide cancer screening program to follow in the footsteps of existing campaigns against cervical and breast cancer has proven considerably more complicated than many had hoped.
Originally scheduled to launch on May 1, the program has been delayed until August, as the government tries to iron out the details. Health minister Tony Abbott has been adamant the August date will stick, and experts say they are confident it will.
But even as they praise the plan as ``historic'' and ``a breakthrough'', they say there are several potential problems that have not been adequately addressed.
Funding from the federal government will cover the screening test mailout and analysis, information and a helpline, and monitoring and evaluating the program. But the screening test itself cannot say conclusively whether a person has bowel cancer or not _ to determine that patients need to go for a follow-up colonoscopy.
That's a far more intrusive, and expensive, procedure that requires specially trained professionals to carry it out. But for patients who test positive but do not have private health insurance, it will be the state governments _ not the Commonwealth _ who foot the bill. And therein lies the problem, according to Macrae.
``The biggest strain is going to be on the capacity of the healthcare system to follow up positive results,'' he says.
Ensuring that the approximately 8 per cent of patients who test positive on the screening test are able to access colonoscopies in a timely manner is central to the success of the program, both Macrae and Young say. They worry that as things stand there won't be enough support to meet the expected increase in demand, and already unacceptable waiting lists for colonoscopies will worsen.
``There's a lot of homework to do in the next couple years,'' Macrae says.
In Queensland the average wait time for a colonoscopy is 12 months, while in Western Australia it is about nine months, according to Young.
``The pilots provided a financial resource for the colonoscopies and wait times were reasonable _ about four to six weeks.
``Our concern is that without that the public health care system will become truly stressed and waiting lists are going to lengthen, even in the states where the wait is ordinarily two to three months now,'' he says.
More colonoscopists will also need to be trained in order to keep up with the expected increase in demand down the track.
But there are other dilemmas as well.
While the program will officially launch in August, not everyone in the target 55 to 75 age bracket will be eligible to participate. Not this year, anyway. The program will only be offered to people who turn 55 and 65 this year, as well as those who participated in the pilot studies. Next year the following group of people who turn 55 and 65 will be invited to participate, so more people will be added each year.
The idea is that the staggered delivery will allow time for deficiencies to be plugged up and create a more manageable roll-out over a decade.
But what happens if you're 66 this year?
Young and Macrae say best not wait another nine years for the free government screening. If you are in the target age group, ask your doctor about the test. Just because you haven't been approached with a letter doesn't mean you can't get screened _ and the cost of the test averages about $25.
As for the national screening program itself, Macrae says the gradual rollout is more of a secondary pilot than a fully formulated policy.
``There's no better way to test the water than to turn the switch,'' he says.
That means it will most likely be a decade before the program realises its potential, assuming it continues past 2008, when the government reassesses the budget to determine how it should proceed.
Until then, many experts will probably be keeping their fingers crossed.