The National Bowel Cancer Screening Program: Consequences for practice

Background: The Australian Government introduced the National Bowel Cancer Screening Program (NBCSP) in 2006, in which Australian residents are offered a faecal immunochemical test (FIT) for haemoglobin when they turn 50, 55 and 65 years. We describe waiting times, quality of existing colonoscopic services, and quality of documentation of ongoing surveillance activities in those with a positive FIT. Methods: A retrospective review of case notes of patients undergoing colonoscopy in public tertiary hospitals in South Australia, identified through the NBCSP (pilot and phase 1 and 2 groups). Results: Records on 433 patients were assessable, representing 65% of public NBCSP cases. Colonoscopy waiting times varied, with only 23% of patients undergoing colonoscopy within the 30 day benchmark. The polyp retrieval rate was 98.4%. Surveillance recommendations after a polyp result were considered appropriate in 55% cases; with inappropriate intervals usually being set too early (59%). Where structured recall systems were utilised, appropriateness of follow up surveillance significantly improved. Conclusion: Overall, quality of colonoscopy was good. Waiting times were delayed with a minority of cases meeting the benchmark 30 day waiting time. Recommended surveillance colonoscopy intervals deviated from the guidelines in nearly half of patients, with a tendency to colonoscope too frequently according to the guidelines. More structured recall systems would be expected to reduce this excessive workload.