In 1997, the Australian Health Technology Advisory Committee of the National Health and Medical Research Council published a recommendation that Australia introduce a bowel cancer screening program using foecal occult blood testing. At that time there were three randomised controlled trials that showed a reduction in deaths from Australia’s second biggest cancer killer.
Australia has one of the highest global incidence rates of bowel cancer with recent estimations showing that one in 12 Australians are likely to develop the disease before the age of 85. In 2007 there were 14,234 new cases of bowel cancer, representing 13% of all new cases of cancer (excluding non-melanoma skin cancer). That same year, 10% of all cancer deaths, 4047 deaths, were attributed to bowel cancer.
Since its introduction in 2006 the National Bowel Cancer Screening program has only targeted people turning 55 and 65 with a one-off test, with 50-year-olds added in 2008.
On May 5, Treasurer Wayne Swan and Health Minister Tanya Plibersek announced $49.7 million over four years to expand the program in preparation for an incremental shift to full implementation. Thanks to these new budget funds, 60-year-olds will be added next year and 70-year-olds in 2015; the government plans to thereafter start rescreening everyone aged 50-74 every two years, starting with 72-year-olds in 2017.
Some people are unhappy, suggesting it is too little too late.
The Cancer Council has been campaigning for a full rollout of this life-saving program since the implementation of the National Bowel Screening Program in 2006 and of course we’d have liked to see it implemented earlier. But we can only change the future, not the past.
The progressive rollout of the program makes sense. The infrastructure to distribute the kits, do the analysis and promote the program more broadly in the community, as well as the capacity to provide the necessary follow-up colonoscopy and other services for those with a positive test needs to be built, carefully and systematically.
Many parliamentarians, from all sides of politics, have put real time, effort and energy into supporting the program and they should all feel pleased with their efforts as we launch into a tough and tight federal budget.
So how has this historic milestone for cancer screening come about with such a tough budget predicted? This is a case of good policy triumphing despite, maybe even because of, politics.
Let’s not pretend — screening programs are not cheap. And they keep on going. Once put in place it is extremely hard for any government to undo cancer screening. So the case needs to be clear, sound and built on firm evidence and solid programmatic experience.
And this program ticks all those boxes and more. But it also needed to be “sold”.
Most recently we launched the “Get Behind Bowel Screening” campaign. More than 24,000 Australians signed up and communicated their support to federal members of parliament of all persuasions.
A committee of people from all state Cancer Councils have been working on this campaign for more than four years. There has been enormous effort invested by the scientists, researchers and clinicians who did the research over 30 years or more. There have been staff, volunteers, very supportive journos, pollies, their staff and many, many more. And of course many other organisations have put their shoulder to the wheel.
The key to this campaign has always been — “play the ball not the man”. That is — stick to the facts, the evidence and the argument. With those on your side — the next vital ingredients are persistence and patience. Sometimes a little bit of nous (sometimes in surprisingly short supply) helps too.
Credit for this success must first go to the people who made the big decision to go down this track. Swan, Plibersek and Prime Minister Gillard deserve a cuddle.
But this is “the beginning of the beginning”, to torture a Churchillian notion. There is much work to be done for this to happen the way it should. We need to ensure potential screenees understand the test, its benefits (and some potential harms) and how to go about using it.
We need to build on, and improve, high quality systems to ensure a world-class screening program. And we can do that confident in the knowledge that less people will die from bowel cancer as a result. A worthwhile goal for us all to pursue I’d suggest.
It is easy to be cynical and to grizzle and moan about what is not working — but it should make our collective hearts a little warmer to see the decision-making system — for all its flaws — delivers a worthwhile result.