Bowel cancer screening and FOBT follow-up

Overview

Bowel cancer is one of Australia's commonest cancers; in 2025 an estimated 6,941 people aged 50–74 were diagnosed (about 47% of all bowel cancers) and 1,779 died of the disease. Screening exists because the disease offers a long preclinical window: detect and remove the adenoma and the cancer never arrives.^[15]

The National Bowel Cancer Screening Program began in August 2006 and mails a free immunochemical faecal occult blood test every two years to Australians aged 50–74; since 1 July 2024 those aged 45–49 have also been able to request a kit through the National Cancer Screening Register, though the youngest cohort sits outside the core performance indicators for now. About 14.3 million tests have been completed and at least 17,378 bowel cancers diagnosed through screening; programme participants who were later diagnosed with bowel cancer had lower death risk and less advanced disease.^[15] Yet participation was only 42.0% in the 2023–2024 round, against 83.5% re-participation among previous participants — the first kit is the hard one, and the gap between a working programme and a finished job is the general practice waiting room.^[15]

Risk shapes the pathway around the programme. A single first-degree relative diagnosed before 55, or two affected relatives, moves a person from population screening into colonoscopic surveillance at earlier ages and shorter intervals. Lynch syndrome — suspected on family-history criteria or found through universal tumour mismatch-repair testing — carries metachronous cancer risk after segmental colectomy and demands lifelong intensive surveillance.^[14]

References15ShowHide

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