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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

A colonoscopy should not be ordered as a screening test for bowel cancer in patients that are average or slightly above average risk.  The correct screening test for an asymptomatic person over 50 year old is a faecal occult blood test.

An average or slightly above average risk person includes someone who has one first-degree relative who was diagnosed with bowel cancer after turning 55 years old.

Higher than average risk is when an asymptomatic person has two or more first-degree relatives with bowel cancer or a first degree relative with bowel cancer diagnosed at younger than 55 years old. The number of second degree relatives may also be a factor in determining higher risk (e.g. one first degree relatives and two second degree relatives).

This advice is consistent with the Cancer Council Australia guidelines, which are endorsed by the National Health and Medical Research Council (NHMRC). The Medicare Benefits Schedule’s revised colonoscopy item numbers reflect this advice.

When is the procedure indicated?

A colonoscopy can be performed as a screening test in patients who are at higher risk of bowel cancer due to a pre-disposing history (inflammatory bowel disease or personal/family history).

This advice is consistent with the Cancer Council Australia guidelines, which are endorsed by the NHMRC.

Best care recommendations

A faecal occult blood test (FOBT) should be used for average or slightly above average risk patients as the first measure to screen for bowel cancer.

An FOBT can be arranged through a primary health-care provider, or, if a patient is aged between 50 and 74, they are eligible for the government-funded National Bowel Cancer Screening Program.

If any abnormalities are detected through an FOBT, further diagnostic assessment is indicated.

Evidence

Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer [Internet]. Sydney (NSW): Cancer Council Australia; 2017 [cited 2020 Jun 13].

Department of Health and Human Services. Specialist clinics resources: The Victorian Endoscopy Categorisation Decision Support Tool [Internet]. Melbourne (VIC): Department of Health and Human Services; 2017 [cited 2020 Nov 20].

Jenkins MA, Ait Ouakrim D, Boussioutas A, Hopper JL, Ee HC, Emery JD, Macrae FA, Chetcuti A, Wuellner L, St John DJ. Revised Australian national guidelines for colorectal cancer screening: family history. Medical Journal of Australia. 2018 Nov;209(10):455-60.

NPS MedicineWise. Choosing Wisely Australia recommendations [Internet]. Sydney (NSW): NPS MedicineWise; 2020 [cited 2020 Jun 13].

 

Page last updated: 08 Feb 2021

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