Lew, Jie Bin, Feletto, Eleonora, Worthington, Joachim, Roder, David, Canuto, Karla, Miller, Caroline, D'onise, Katina, and Canfell, Karen (2022) The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: Modelling study. Journal of Cancer Policy, 32. 100325.

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Abstract

Background: Australian Aboriginal and Torres Strait Islander peoples experience health and socioeconomic disparities, including lower life-expectancy, have a younger mean age of colorectal cancer (CRC) diagnosis, and lower CRC survival than non-Indigenous Australians. The National Bowel Cancer Screening Program (NBCSP) provides biennial CRC screening for Australians aged 50–74 years to reduce the burden of CRC. The 2019 participation rate was 42% nationwide and 23% in Aboriginal and Torres Strait Islander peoples. For Aboriginal and Torres Strait Islander peoples, this study aims to estimate the health outcomes and cost-effectiveness of the current NBCSP and extensions to include people < 50 years. Methods: An existing microsimulation model, Policy1-Bowel, was adapted to the Aboriginal and Torres Strait Islander population and was used to evaluate three strategies assuming biennial iFOBT screening from 50-74, 45–74, or 40–74 years under two participation scenarios: 23% and 42% per screening round (psr.). Results: At 23–42% participation psr., the current NBCSP was predicted to reduce lifetime CRC incidence and mortality by 14–24% and 23–39%, respectively, be cost-effective (incremental cost-effectiveness ratio <$13,000/life-year saved), and be associated with a benefits-and-burden balance of 51-53 number-needed-to-colonoscope (NNC) per CRC death prevented of. Lowering the screening start age to 40(45) would further reduce CRC incidence and CRC mortality by 7–11(4–5) percentage points, be cost-effective, and be associated with an incremental NNC- of > 95 (> 60). Conclusion: For Aboriginal and Torres Strait Islander peoples, the current NBCSP is cost-effective but participation is limited. Lowering the screening start age will further reduce CRC incidence and mortality. Policy summary: These findings highlight a need to increase NBCSP participation whilst exploring the feasibility and acceptability of lowering the NBCSP start age for Aboriginal and Torres Strait Islander peoples. These findings could inform new co-designed, community-led strategies to improve CRC outcomes for Aboriginal and Torres Strait Islander peoples.

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