Bowel cancer screening in Australia

About 1 in 17 Australians will be diagnosed with bowel cancer during their lifetime. That is a lot of people — and it is natural to feel anxious when you hear numbers like that. But here is the reassuring part: when bowel cancer is caught early, the chances of a full recovery are good. Stage I bowel cancer has a five-year survival rate approaching 99%. The challenge is that early bowel cancer — and the small growths called polyps that can become cancer over time — usually cause no symptoms at all. By the time you notice something is wrong, the disease may have already progressed. This is why screening exists: it looks for cancer and pre-cancerous polyps before your body gives you any warning signs.

The Australian Government runs a free screening programme called the NBCSP (National Bowel Cancer Screening Program). If you are aged 50 to 74, a free home test kit is automatically posted to you every two years. Kits are also available on request for people aged 45 to 49. The test is called an FOBT — a faecal occult blood test (FOBT). "Occult" simply means hidden: it picks up tiny traces of blood in your stool that are too small to see. If blood is found, a follow-up colonoscopy — a camera examination of the bowel — is needed to find out why.

• The kit is sent to your home automatically when you become eligible
• You collect a small sample from two separate bowel motions on different days
• Both samples go back to the laboratory in the prepaid reply envelope — no cost to you
• Your results are posted to you and your GP within 2–4 weeks

You do not need to fast, change your diet, or do any preparation. The whole process takes just a few minutes and is painless. Unfortunately, fewer than half of Australians who receive a kit actually return it. That matters, because every kit that goes unused is a missed chance to catch something early — when treatment works best.

The standard two-yearly FOBT is the right starting point for most Australians. But some people have a higher-than-average risk and need to start earlier, or have a colonoscopy instead of relying on the FOBT alone. You may be in this group if:

• One first-degree relative (parent, sibling, or child) diagnosed under 55, OR two first-degree or second-degree relatives at any age: this is the NHMRC moderate-risk category — colonoscopy is recommended from age 50, or 10 years before the youngest affected relative was diagnosed (whichever is earlier), repeated every 5 years.
• Three or more first-degree or second-degree relatives with bowel cancer on the same side of the family: NHMRC high-risk category — colonoscopy from age 40, every 5 years, and a referral to a familial cancer clinic for genetic assessment.
• You have previously had polyps (small growths in the bowel): your specialist will recommend regular colonoscopies at intervals based on the type and number found.
• You have had bowel cancer before: regular check-up colonoscopies after treatment are a standard part of your ongoing care.
• You have inflammatory bowel disease (Crohn's disease or ulcerative colitis): regular colonoscopies are recommended; how often depends on how long you have had the condition and how much of your bowel is affected.
• You have a known or suspected hereditary condition such as Lynch syndrome or FAP (familial adenomatous polyposis — a condition that causes many polyps to grow): a referral to a genetics specialist is the right next step.

If your result comes back positive, the next step is a colonoscopy — ideally within 30 to 60 days. It is understandable to feel worried when you get this news, but please do not let that worry stop you from following it up. Your GP can refer you to a colorectal surgeon who will arrange the colonoscopy. If you have received a positive result and have not yet taken the next step, please call our rooms on (03) 9816 3951 or ask your GP to refer you to Mr Nguyen. We are here to help, not to alarm you.

The NBCSP screening programme starts at age 45, but that does not mean you can relax until then if something feels wrong. If you are under 45 and have noticed any symptoms — blood in your stool, a change in your bowel habits, persistent abdominal pain, unexplained weight loss, or persistent tiredness — or if a close family member has had bowel cancer or polyps, please do not wait. Speak to your GP about a referral to a colorectal surgeon regardless of your age. Bowel cancer in younger adults is becoming more common, and your age does not make your symptoms safe to ignore.