The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: Modelling study

Jie-Bin Lew; Eleonora Feletto; Joachim Worthington; David Roder; Karla Canuto; Caroline Miller; Katina D'Onise; Karen Canfell

doi:10.1016/j.jcpo.2022.100325

The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: Modelling study

J Cancer Policy. 2022 Jun:32:100325. doi: 10.1016/j.jcpo.2022.100325. Epub 2022 Feb 8.

Authors

Jie-Bin Lew¹, Eleonora Feletto², Joachim Worthington³, David Roder⁴, Karla Canuto⁵, Caroline Miller⁶, Katina D'Onise⁷, Karen Canfell⁸

Affiliations

¹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia. Electronic address: [email protected].
² The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia. Electronic address: [email protected].
³ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia. Electronic address: [email protected].
⁴ Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia. Electronic address: [email protected].
⁵ Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Australia. Electronic address: [email protected].
⁶ Health Policy Centre, South Australian Health and Medical Research Institute, Australia; School of Public Health, University of Adelaide, Australia. Electronic address: [email protected].
⁷ School of Public Health, University of Adelaide, Australia; Prevention and Population Health, Wellbeing SA, Australia. Electronic address: Katina.d'[email protected].
⁸ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia. Electronic address: [email protected].

PMID: 35560263
DOI: 10.1016/j.jcpo.2022.100325

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.

Keywords: Aboriginal and Torres Strait Islander peoples; Australia; Colorectal cancer screening; Cost-effectiveness; Indigenous population.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Australian Aboriginal and Torres Strait Islander Peoples* / statistics & numerical data
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / mortality
Early Detection of Cancer*
Humans