The Minister of Health has confirmed that a four year pilot will begin next year to assess whether New Zealand should introduce a national bowel cancer screening programme. The Minister of Health gave the green light to the pilot in a 2010 pre-budget announcement. The Government will provide $24 million funding over four years. The pilot follows the generally accepted practice of testing a screening programme with a smaller population before making any decision to adopt it nationally.

It is expected the pilot will begin by late 2011, and will run in one or two District Health Board areas with a minimum sample population of 60,000, including at least 6000 Mâori. Eligible people aged 50 to 74 years living in the DHB area will be invited for screening once every two years during the pilot.

No decision will be made on implementing a national bowel screening programme until the pilot is completed in 2015 and all monitoring and evaluation data has been analysed. This will determine the level of participation, the number of cancers that were detected, the stage of the disease at diagnosis, the impact on health services and the costs involved.

The Ministry of Health will shortly call for expressions of interest from DHBs wishing to submit a proposal to establish and operate the pilot. The pilot will follow the most common model used for population-based screening programmes overseas.

This involves a central organisation mailing a faecal occult blood test to all eligible people which they can complete in their own home and post to a laboratory for assessment. A person with a negative result will be recalled in two years for a repeat test. A person with a positive result will be followed up and offered a diagnostic colonoscopy.

Bowel screening programmes are either running or are being piloted in Australia, the United Kingdom, most countries in the European Union, Korea, Japan, Israel and parts of Canada.

For queries or further information, please contact:

Mhairi Porteous, Bowel Cancer Programme Manager
Mhairi_Porteous@moh.govt.nz

Questions and Answers

How common is bowel cancer in New Zealand?
Bowel cancer is the most frequently diagnosed cancer and the second highest cause of cancer death in New Zealand.  New Zealand has the third highest bowel cancer death rate in the OECD for women, and the sixth highest for men. In 2007, 2890 people were diagnosed with bowel cancer and 1252 people died from the disease.  By 2016 the number of new cases of bowel cancer diagnosed each year is projected to increase by 15 percent for men and 19 percent for women to 3302 (for all ages).  This figure is likely to increase further if there is a national bowel screening programme as screening will detect more cancers.

Who is most at risk of developing the disease?
The incidence of bowel cancer increases with age and rises steeply from the age of 50.  The risk factors are age (above all), gender, ethnicity and diet.  Bowel cancer affects more men than women.  Scientists believe a diet high in animal fats and low in fruit and vegetable fibre may contribute to the development of bowel cancer.

How successfully can bowel cancer be treated?
People who are diagnosed with bowel cancer, and receive treatment when it is at an early stage, have a 95 percent chance of surviving five years.  After five years they have the same survival rate as someone who has never had bowel cancer.  If there is a delay in diagnosis and treatment, and the cancer spreads regionally, the five year survival rate drops to 70 percent, and then plummets to 10 percent where there is distant spread.

What is bowel screening?
Bowel screening involves people within a certain age range being asked to take a screening test called an immunochemical faecal occult blood test (iFOBT). An iFOBT is used to detect blood in faeces (bowel motions).  People with blood in their faeces will be offered a diagnostic colonoscopy, which can detect polyps and cancers if they are present. Polyps can usually be removed during a colonoscopy.

How can bowel screening help?
Bowel cancers develop slowly and screening increases the likelihood that they will be detected at an early stage. People who are not screened are usually diagnosed at a later stage when the cancer is more likely to have spread and is more difficult to treat successfully.  Up to 8 percent of people who return a sample are likely to have a positive result, which means they have blood in their faeces.  Between 30 and 40 percent of these people will have polyps and between 4 and 8 percent of them will have cancer.  These predictions are based on overseas data but the pilot will determine the New Zealand situation.

What will the screening process be during the pilot?
Eligible people will receive a faecal occult blood test in the mail which they can complete at home.  They will collect a sample of faeces using the kit provided and return this to the selected laboratory service for assessment.  A person with a positive result (where blood has been detected in their faeces) will be followed up and offered a diagnostic colonoscopy. A person with a negative test will be recalled in two years for a repeat test.  A diagnostic colonoscopy will determine whether a person has cancer or whether they have polyps, which can develop into cancer. 

What is a colonoscopy?
This is where the doctor inspects the entire length of the large bowel using a long, flexible tube called a colonoscope.  The doctor may take a small sample of tissue, which is examined under a microscope, or remove polyps.  Other means of diagnostic testing also exist.

Is the screening test accurate?
New Zealand will use the latest immunochemical faecal occult blood test (iFOBT).  This test identifies about 70 percent of cancers.  The test is repeated every two years to give the greatest chance of identifying cancers at an early stage.

Can bowel screening save lives?
International evidence shows that bowel screening programmes can save lives through early diagnosis and interventions.  Modeling from Ireland indicates that after 10 years of a national screening programme for 50 to 74 year olds, using the iFOBT test, 36 percent of bowel cancer deaths could be avoided. In Ireland, where the sample population is a similar size to New Zealand’s, that equates to up to 270 lives saved every year. The bowel screening pilot will provide data so we can determine how many lives could be saved in New Zealand. A reduction in the number of deaths would be expected to be seen after the first two years of screening.

Do other countries have bowel cancer screening programme?
In recent years, population based bowel screening programmes have been introduced in many countries and others have begun large scale pilots to determine the feasibility of such a programme in their country.  Bowel screening programmes are either running or are being piloted in Australia, the United Kingdom, 19 of 23 countries in the European Union, Korea, Japan, Israel and parts of Canada.

How will providers be selected to run the pilot?
The Ministry of Health will call for expressions of interest from providers.  The successful provider/s will need to meet stringent criteria.  This will include having a minimum sample population of 60,000 people in the 50 to 74 year age band, including a minimum of 6000 Māori.  These numbers are required to ensure the pilot provides enough information to estimate the likely cancer detection rate overall and to inform wider analysis.

When will a decision be made on whether to launch a national bowel screening programme?
No decision will be made until the pilot is completed in 2015 and all monitoring and evaluation data has been analysed.  This will determine the level of participation, the number of cancers that were detected, the stage of the disease at diagnosis, the impact on health services and the costs involved. Bowel cancer patterns from the pilot area will be compared to areas where there is no screening programme.

How much will the pilot cost?
The total cost of the pilot is estimated to be around $31 million over five years.

What is the estimated cost of a National Bowel Cancer Screening Programme?
The total cost of a national bowel screening programme for people aged 50 to 74 years is estimated to be about $60 million a year, plus the cost of establishing a supporting information system.