The role of health professionals and providers in the National Bowel Cancer Screening Program

Primary care providers, colonoscopists and pathologists all have important roles to play in the National Bowel Cancer Screening Program. Find out how you can support and encourage your patients to participate in the program.

Impact of COVID-19 on bowel cancer screening

The National Bowel Cancer Screening Program is still operating, but the COVID-19 pandemic is straining the health system. So there might be delays for follow-up medical appointments, tests or procedures.

If you receive a positive iFOBT result for a participant, consider seeing your patients via telehealth, to help stop the spread of COVID-19.

Continue to refer your patients to colonoscopy services for further investigation, where appropriate. Patients without symptoms might have to go on a waiting list. But a small delay is likely to be very low risk, as most cancers are slow growing.

We asked Cancer Council NSW to model the possible impact of COVID-19 on our 3 national cancer screening programs. They examined a variety of scenarios and analysed the potential impact. Read their reports.

Healthcare Provider Portal

The National Cancer Screening Register has launched a healthcare provider portal to help health professionals access and submit bowel and cervical screening data electronically. Use the portal to:

  • access your patient’s bowel and cervical screening results and histories online
  • prepare for patient appointments by checking their records
  • submit forms and reports electronically
  • update your patient’s information
  • order a bowel screening kit for a patient.

Read more about using the portal on the register’s website.

Role of practice nurses

Practice nurses have an important role to play in encouraging and supporting patients to participate in the program.

To encourage your patients to screen, you can:

  • promote the program in your practice
  • do a screening audit of practice records
  • talk to your patients aged 49 to 74 about screening
  • send a letter to 49-year-old patients to encourage participation in the program
  • find out when patients will receive a kit and, if appropriate, encourage participation
  • show patients how to use a bowel screening test kit
  • help patients complete the participant forms
  • refer patients (of any age) with symptoms, bowel disease or family history of bowel disease to a GP.

The Australian Primary Healthcare Nurses Association has developed resources and training on the program for nurses. The Cancer Council WA helped develop these resources, and the Department of Health funded the work.

Role of general practitioners (GPs)

GPs play a key role in ensuring that program participants progress through the screening pathway. GPs deliver:

  • clinically appropriate advice
  • services
  • treatment and care
  • data on participants and their outcomes to the National Cancer Screening Register.

For your patients, you can:

  • encourage people to participate if they receive a screening test and the test is clinically relevant for them
  • assess people with a positive result and refer them for further examination as clinically indicated – for example, a colonoscopy
  • notify the register about referrals or non-referrals for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the program’s GP Assessment Form by fax, post or electronically through the Healthcare Provider Portal.
  • inform patients at average to slightly above average risk that the approved guidelines from the NHMRC (National Health and Medical Research Council) recommend screening every 2 years, starting at age 50 and continuing to age 74
  • manage patients identified as being at increased risk of bowel cancer as per the NHMRC-approved guidelines
  • manage patients (of any age) with symptoms as per the NHMRC-approved guidelines.

What is my duty of care as a GP in relation to the program?

The program does not impose any extra duty of care on doctors. However, GPs should be aware that the actions they take should align with professional standards.

Some approaches you can take if you receive a positive test result for a program participant are to:

  • contact the participant to initiate a GP appointment
  • follow up patients who fail to attend GP or colonoscopy appointments, if required
  • advise the register if a GP or practice receives a result for a participant who is not known to them, or who they are unable to accept as a patient. The register will remove the GP’s contact details from the register and contact the participant to ask them to make an appointment with another GP.

See RACGP Standards for General Practice – Criterion GP2.2 – Follow up systems for more details.

How can general practices support participation in the program?

Patients are more motivated to take part in a program if a primary care provider recommends participation. General practices can encourage their patients to participate by:

Several resources are available for general practice to learn more about the program and how to encourage participation:

Send a letter or SMS to your patients

Research shows that sending a letter endorsing bowel screening, signed by the patient’s GP, is an effective way to increase participation in bowel cancer screening.

GPs can use this template letter to recommend screening to patients outside of regular consultations. Currently, 50-year-olds have the lowest participation rate in the program. General practices should aim to send the letter to 49-year-old patients to encourage them to do the test when they receive it in the mail around their 50th birthday.

Alternatively, you may wish to send the following SMS to your 49-year-old patients:

Around your 50th birthday you will be sent a free bowel screening kit.

Please do this test – screening saves lives.

Dr xxxxxxxxxxx

Or you could encourage your 50 to 74-year-old patients to participate by sending the following SMS:

If you’re aged 50 to 74 and eligible, you will be sent a free bowel screening kit.

Please do this test – screening saves lives.

Check when you will be invited at

Dr xxxxxxxxxxx

Health service providers have obligations under the Privacy Act 1988 and relevant state and territory privacy laws when handling personal information. The template letter has been drafted to comply with relevant privacy obligations. If you alter the letter before you send it to your patients, you should consider whether it still meets your privacy obligations.

If you have any queries about your privacy obligations, please email or call the Office of the Australian Information Commissioner.

Role of colonoscopists and pathologists

Gastroenterologists, colonoscopists, surgeons and pathologists play a key role in ensuring that program participants progress through the screening pathway.

Colonoscopists and pathologists deliver:

  • clinically appropriate advice
  • services
  • treatment and care
  • data on participants and their outcomes to the register.

For your patients, you can:

  • identify patients that are program participants when assessing them during a colonoscopy referral, to help with reporting to the register
  • manage patients identified as being at increased risk of bowel cancer as per the NHMRC-approved guidelines, including informed consent, follow-up treatment and/or screening as relevant
  • notify the register of colonoscopy outcomes and any follow-up testing or treatment for a program participant with a positive test result
  • report the results of a colonoscopy and histopathology from testing specimens collected during the colonoscopy using the Healthcare Provider Portal or the relevant program form. This includes during a surgical resection
  • report adverse events that may have occurred during the colonoscopy.

Evidence that the program is effective and saves lives

The NHMRC guidelines recommend bowel screening every 2 years, starting at age 50 and continuing to age 74. This is for people who are at average or slightly above average risk for bowel cancer.

In line with this, from 2020 the program has expanded so that all eligible Australians aged 50 to 74 will be invited to participate every 2 years.

The program’s direct mail model is the most common model internationally. It is also the most effective recruitment method for a population-based bowel screening program.

Of all people screened through the program, who have had a colonoscopy following a positive test result:

  • 1 in 32 have had either a confirmed or suspected cancer
  • 1 in 7 have had an adenoma detected.

The risk of dying from bowel cancer is 40% lower for people diagnosed through the program than for people who have never been invited to screen.

Cancer Council New South Wales estimates that the program prevents 2519 deaths from bowel cancer each year.

For more information about the program​​​​​​, see the National Bowel Cancer Screening Program Monitoring Reports.

Clinical guidelines and resources

Clinical guidelines

Clinical resources

Read our collection of resources for health professionals.

Additional resources include:

  • GP Cancer Screening Education Package this multi-modal educational package developed by True Relationships & Reproductive Health and the Queensland Cancer Screening Unit covers all three national cancer screening programs.
  • Animated interactive videos on bowel screening and colonoscopy – produced by the Queensland Cancer Screening Unit and Healthily, these videos provide information about why it is important to be tested, how the test works, what to expect, what the results mean and colonoscopies.  
  • a bowel screening flipchart and facilitator manual – developed by the Cancer Institute NSW to help you provide education on bowel cancer and bowel cancer screening to women and men from different cultural backgrounds. It is available in English, Simplified and Traditional Chinese, Arabic, Italian, Greek and Vietnamese
  • guides, a training module and webinar – available from the Australian Primary Healthcare Nurses Association
  • QLD Health – bowel screening information video – this 3-minute video for Queensland GPs and practice nurses provides an overview of the program, the effectiveness of the screening test and the role of GPs in bowel cancer screening
  • GP Education Series – this series of 4 short videos from the Victorian Department of Health and the Cabrini Monash University Department of Surgery provide GPs with an overview of the program.

  • Easy English resources for people with an intellectual disability developed by Family Planning NSW – Bob has a bowel screening test booklet (PDF, 5.48MB) and the Just checking video.

  • Poster and fact sheet on how to reduce your risk of bowel cancer developed by the Australian Commission on Safety and Quality and in Health Care.

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