Bowel Screening Program

Question 1

1. What is the National Bowel Screening Program?
2. What are the screening questions?
3. What are the categories of risk?

Answer 1

1. Screening of asymptomatic people 2 yearly from 50 years of age
2. PR bleed/weight loss/change of bowel habit/abdominal pain
3. Category background risk
   - Asymptomatic patients >50
   - Nil Fhx

Categories of intermediate risk
-Asymptomatic patients >50yrs +
x1 first degree relative before 55 yrs OR
x2 1st degree or x1 first + x1 second degree relative on the same side (increases risk to 3-6x)

Categories of high risk
- see NHMRC guidelinens

Question 2

How do you counsel patients about NBSP?

Answer 2

1. Screening is of asymptomatic persons >50 years of age
   2 yearly..
   Role of bowel screening
   - 1 in 19 men and 1 in 28 women will get bowel cancer (life time risk of bowel cancer)

Categorise risk  
(according to NHMRC guidelines) 

Definitive advice on 2 yearly screening

Bowel cancer is more common than cervical cancer

Question 3

+VE FOBT in a patient

1. What does this indicate?
2. Further management

Answer 3

1. polyp, adenoma/ bowel cancer/non neoplastic e.g. proctitis, haemorrhoid
2. Referral for colonoscopy
   Referral should confirm the FOBT +ve result and confirm program participation

Question 4

Complications of colonoscopy

Answer 4

risks of sedation 
risk of bowel prep
risk of perforation
risk of major haemorrhage
risk of death 
risk of complication resulting in surgery/stoma

Question 5

+ve or negative FOBT and requirement to inform national program register

Answer 5

Notify the register

GP Assessment report

Question 6

For intermediate risk patients, what type of screening should be offered?

Answer 6

5 yearly colonoscopy from 50 yrs of age or 10 years younger than the earliest diagnosis of colorectal cancer in the family