Should people have a choice when it comes to their bowel cancer screening test? This is the question being asked leading up to the launch of the first Australian national bowel cancer screening program.
After evaluating cost and reviewing the benefits and harms of alternate screening methods, the Government decided not to offer consumers a choice of screening test.
Eligible people turning 55 or 65 this year will be invited to complete an immunochemical fecal occult blood test (FOBT) in the privacy of their own home and mail it in for analysis.
In his article for the Medical Journal of Australia (MJA), Dr Glenn Salkeld of the University of Sydney says that the Australian Government should seriously consider providing a decision-support system that allows consumers to decide whether they want to take up the offer of screening, based on information of benefits, harms and the process of testing.
The Multicentre Australian Colorectal-neoplasia Screening (MACS) Group has recently conducted a study of their own (also published in this issue of the MJA) to determine whether choice of test improved participation in screening.
People in the target age group from three Australian cities were selected as participants in the study, and offered a range of six screening strategies.
The MACS group discovered that a choice of screening test did not improve participation, but that participation by FOBT was higher than by the other testing methods which conversely may be more accurate for preventing bowel cancer.
This prompted Dr Salkeld to ask whether participation in screening is an appropriate measure of success and whether participation itself is an adequate measure of consumer choice," he said.
"Falling short of a 70% target participation rate shouldn't be taken as a public health failure if it can be shown that consumers have had an opportunity to make an informed choice.
"Unless the program actively engages the community, GPs and pharmacists in screening, the opportunity for an informed choice and participation is limited."