Hon Tony Ryall
Minister of Health
5 May 2010
Questions and Answers
Budget 2010:Funding for bowel cancer screening pilot
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, almost 3000 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 cancer 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 cancer screening?
Screening for bowel cancer 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 the 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 cancer 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 feasibility study will determine
the New Zealand situation.
What will the screening process be during the feasibility study?
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
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 cancer screening save lives?
International evidence shows that a bowel cancer screening programme can
save lives through early diagnosis and interventions. Overseas modelling
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. That equates to about 270 lives saved every year. The feasibility
study will provide data so we can determine if this would apply to the New
Zealand population.
Do other countries have bowel cancer screening programme?
In recent years, population based bowel cancer 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. Countries
with fully established programmes include Australia, Scotland, England and
Wales, Ontario and Alberta (Canada), Japan, Italy and France.
How will providers be selected to run the feasibility study?
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 Maori. These numbers are required
to ensure the feasibility study 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
cancer screening programme?
No decision will be made until the feasibility study is completed in 2015 and all
monitoring and evaluation data has been analysed. Bowel cancer rates from
the study will be compared with rates in areas where there is no screening
project. Data will be used to compare the benefits of a screening programme
with those gained through other health services.
How much will the feasibility study cost?
The total cost of the feasibility study is estimated to be $31 million.
What is the estimated cost of a National Bowel Cancer Screening
Programme?
The total cost of a national bowel cancer screening programme for people
aged 50 to 74 years, once established, is estimated to be about $60 million a
year.
Media contact: Jackie Maher 04 817 9788 or 021 243 7803