On average, one in two men and one in three women will be diagnosed with a form of cancer during their lifetime. Cancer is now the largest cause of disease in Australia, surpassing cardiovascular disease (Cancer Institute NSW). Accordingly, improving cancer screening rates and reducing cancer risk amongst our population are key priorities.
Our Cancer Programs work with primary care and other key stakeholders to increase cancer screening rates and reduce the prevalence of specific risk factors amongst target populations. In particular, our cancer screening and prevention program aims to improve participation in the three national screening programs: cervical, breast and bowel, as well as supporting skin cancer prevention and smoking cessation. This involves integrated cancer focussed strategies in program areas such as quality improvement, chronic disease management, and practice management and accreditation.
Australia has one of the highest incidences of bowel cancer in the world. It is the second biggest cancer killer in Australia and NSW after lung cancer. Bowel cancer screening is recommended for men and women aged 50 years and over. In NSW, 93% of bowel cancer is found in people over 50 years.
National Bowel Cancer Screening Program
The National Bowel Cancer Screening Program (NBCSP) was initiated by the Australian Government, in partnership with state and territory governments, to help detect bowel cancer early and reduce the number of deaths from the disease. Currently, the NBCSP mails a faecal occult blood test (FOBT) kit each year to Australians turning 50, 55, 60, 65 or 70 years of age who hold a Medicare or Department of Veterans' Affairs card (DVA).
The test is completed at home as per the instructions included in the kit, and sent to the laboratory free of charge. Results are provided to the individual directly, as well as to their nominated health professional. Those who receive a positive test result are advised to speak to their GP. Tests are also available to purchase at local pharmacies or to order online at the Bowel Cancer Australia website.
One in eight women in NSW will develop breast cancer in their lifetime; 90% of them will have no family history of breast cancer. Guidelines recommended that women aged 50-74 years have a screening mammogram every two years.
BreastScreen NSW provides free mammography at various fixed and mobile locations for women aged 40 years old and over, particularly targeting those women aged 50-74 years. While no referral is required to use the BreastScreen service, GPs are encouraged to refer their patients, and likewise, patients are encouraged to share their results with their GP.
Cervical cancer is almost entirely preventable – but screening is vital. Around 80 per cent of Australian women who develop cervical cancer do not get screened regularly as recommended, or have never been screened. From 1 December 2017, women in Australia will benefit from a new and more effective screening test for cervical cancer — it’s more accurate and requires testing less often:
- The Pap test will be replaced by a new Cervical Screening Test. This new testing detects infection with human papillomavirus (HPV), the virus that causes abnormal changes in the cells of the cervix, which if left untreated may eventually lead to cervical cancer.
- Women should have a Cervical Screening Test every 5 years instead of a Pap test every 2 years.
- Women with a normal screening history will be due for their first Cervical Screening Test 2 yearsafter their last Pap test.
- Women will be invited to start screening at age 25 and should have a final (exit) test when they are aged between 70 and 74 years.
The new human papillomavirus (HPV) test will prevent up to 30 per cent more women from developing cervical cancer because it detects HPV, an early risk indicator for cervical cancer. The Pap test detects cervical abnormalities after they occur. The procedure to collect the sample is the same.
Australia was one of the first countries to roll out a national cervical cancer immunisation program using Gardasil, which protects young women from four strains of HPV. And the new version of the vaccine, Gardasil 9, will protect women against a further five strains of HPV, or approximately 90 per cent of HPV-related cervical cancers.
From 1 January 2018, the vaccine will be offered through the National Immunisation Program as part of school based vaccination programs and as part of a catch up program for individuals up to the age of 19 years. Even with the vaccine, it’s important that women continue to have cervical screening.
Resources for practices
The National Cervical Screening Program Guidelines for 1 December 2017 onwards, can now be accessed at the Cancer Council Australia website.
Education and Training courses for GPs and practice nurses can be found at Family Planning NSW.
The Pathology Test Guide for Cervical and Vaginal testing provides context for using the variations of cervical screening and shows what to write on the pathology request form on the Dept of Health website.
Understanding the National Cervical Screening Program Management Pathway: a guide for health professionals is also a useful reference to help ensure the correct test is requested from the Dept of Health website.
A comprehensive summary of information about the Renewal of the National Cervical Screening Program, resources for patients and where to go for more details can be found at the Cancer Institute NSW.
Support for practices
MPHN can work with practices to ensure female patients are screened through:
- Support to identify patients due and overdue for screening, including accessing lists from the pap test register / National Cancer Screening Register
- Support to implement recall and reminder systems
- Provision of appropriate resources