Fears over colonoscopy wait-list blowout
Australians with a positive screen for bowel cancer are unlikely to get a diagnostic colonoscopy within the recommended timeframe, according to a new report.
Figures from the AIHW’s National Bowel Cancer Screening Program: monitoring report 2018 show that there is only one state or territory – Victoria – where 90% of patients aged between 50 and 74 get a colonoscopy within 120 days of a positive FOBT test. In Australia’s most populous state, New South Wales, patients are likely to wait an extra month on top of the recommended 120 days, while in South Australia the wait is 182 days. Research has shown that patients who wait for more than 120 days have statistically poorer outcomes.
Nor is the trend moving in the right direction. In Victoria and ACT, waiting times are slightly down on the previous year, but in all other states and territories they are up, in some cases substantially. Waiting times in Tasmania and the Northern Territory have risen by around a month year-on-year. In the Top End, positively screened patients now wait 197 days for a colonoscopy, more than two months longer than the recommended period.
“People who receive a positive screen or experience bowel cancer symptoms must receive a timely follow-up colonoscopy, or the opportunity for early detection is lost,” says Sydney-based colorectal surgeon and Bowel Cancer Australia spokesperson Associate Professor Graham Newstead.
“We know 90% of bowel cancer cases can be successfully treated if detected early,” he adds.
The problem is likely to be further exacerbated as the national screening program expands and efforts are ramped up to increase participation. By 2021, demand for colonoscopies is set to exceed 1 million per year, it has been estimated.
Meanwhile, new research published in Australian Journal of General Practice suggests that a significant proportion of the colonoscopies that are carried out are actually performed on the wrong people.
Around 80,000 of the 700,000 colonoscopies performed in 2012-213 were on people over 50 with only an average risk of bowel cancer. The study authors, led by Professor Jon Emery of the University of Melbourne, say their modeling shows these people are being overscreened and should be given an FOBT test instead. That would free up capacity for the 29,000 people who are at greater risk and who are not getting colonoscopies, the authors say.
“The large variations in colonoscopy rates in Australia suggest that many people at average risk of colorectal cancer are choosing to have colonoscopy as a screening test, mostly through GP referrals to private endoscopists and funded, at least in part, through MBS payments,” the authors write.
Professor Emery says colonoscopic overscreening can be managed by GPs through correct referral pathways depending on the patient’s risk of bowel cancer.
“It is alarming that so many Australian patients are undergoing unnecessary colonoscopies and potentially putting other patients at risk of delayed diagnosis,” Professor Emery says.
Currently, over 40% of colorectal cancers are diagnosed at Stage 3 or 4 in Australia, which along with New Zealand has the highest rate of colorectal cancer in the world.
You can access the full study here.