FREQUENTLY ASKED QUESTIONS

PROGRAMME FOR THE PREVENTION OF BOWEL CANCER & FINANCIAL DISCLOSURE

The following information provides an overview of a Bowel Cancer Prevention Programme (BCPP) established for the Victorian community by a team of medical experts. This Programme is a health initiative, funded by the Melbourne Endoscopy Group of Day Hospitals. Tests arranged for patients may be done at a Melbourne Endoscopy Day Hospital. Any individual wishing to undertake a test will only be accepted for such a procedure if they have a valid referral from a General Practitioner (GP). No member of our Specialist Assessment Panel performs any of the endoscopic procedures. However, this Panel comprises three Directors of Melbourne Endoscopy Group, each of whom has a financial interest in the Melbourne Endoscopy Day Hospitals. Detailed information on involvement in the Programme will be provided directly to participants by the Programme’s medical team.

1. WHAT IS THE PROGRAMME ALL ABOUT?

This Programme is about raising community awareness about bowel cancer with the aim of preventing bowel cancer in higher than average risk individuals. Bowel cancer is the MOST COMMON INTERNAL CANCER in the Australian community and is thought to be preventable in the majority of people because most cancers arise from benign growths called polyps that can be easily detected and removed.

The BCPP consists of two phases:

The initial part provides information, education and risk assessment by our Specialist Medical Assessment Panel at no cost to you. In the second phase, if you return a completed Questionnaire, the Specialist Medical Assessment Panel will assess your risk category (again without cost) and the appropriate test for you. If you are at higher than average risk, it will then be suggested that you see a GP who may refer you for tests which could involve medical and hospital costs, irrespective of where these are done.

This programme differs from the Commonwealth Government sponsored stool test (NBCSP) which detects blood in the bowel motion and is aimed at early cancer detection. However, many polyps and cancers do not bleed at the time of the test, therefore a negative stool test does not mean your bowel is free of polyps or cancer. Our programme is aimed at bowel cancer prevention by use of colonoscopy in higher than average risk individuals.

2. WHO IS AT RISK FROM THIS TYPE OF CANCER?

Current medical data reveals the lifetime risk of bowel cancer to be 1:20 for most people and to become evident at age 40 and progressively increase with age. It is for this reason that many experts believe regular checks for bowel cancer should, for the majority of individuals, commence at age 50. There are some individuals who have a higher than average risk of developing bowel cancer (up to 1:10), due to the presence of specific factors, namely;

(a)  family history - a parent, brother, sister, son or daughter who has/had cancer/polyps of the large bowel,
(b)  an individual who has/had bowel cancer,
(c)  an individual who has/had bowel polyps, which are small, non cancerous growths in the bowel,
(d)  age - individuals older than 50 years have an increased risk of developing bowel cancer which continues to increase as they grow older,
(e)  an individual who has/had inflammatory disease of the bowel.

3. WILL I NEED MEDICAL CHECKS OR TESTS?

To enter the Programme, please read all the material sent to you, complete the questionnaire and return it in the Reply Paid envelope. A questionnaire and full information are also enclosed for your spouse or partner should he/she wish to be involved.

Once you have completed and returned the questionnaire, the Programme’s Specialist Medical Assessment Panel will assess your risk factors and respond to you using the following guidelines:

(a)  Individuals under the age of 50 or over 75 with no risk factors or symptoms will receive no further correspondence at this time, but they should get in touch with a GP if symptoms occur or their circumstances change.
(b)  Individuals between 50 and 75 years of age with no other risk factors or symptoms will be advised to consult a GP and to enter a Prevention Programme. The GP may suggest a faecal occult blood test (FOBT), flexible sigmoidoscopy or the BCPP’s preferred option of 5 – 10 yearly colonoscopy, because this reflects the world’s most up to date and best practice.
(c)  Individuals over 40 years of age and at "higher than average risk" will be advised to attend a GP who should recommend a colonoscopy, if your general health status permits.
(d)  Individuals who have rectal bleeding and/or recent change in bowel habit will be advised to see a GP who may recommend a colonoscopy, if your general health status permits.
(e)  Individuals over the age of 75 who fall into the higher than average risk group for reasons other than age (eg family history) will be advised to see a GP who may recommend a colonoscopy, if your general health status permits.

Colonoscopy uses a flexible lighted tube to examine all of the large bowel and is usually done under sedation (light anaesthetic), requires prior bowel cleansing and preparation and involves attendance for approximately three hours at a Specialist Day Hospital, Private Hospital or Public Hospital.

Colonoscopy is a safe routine medical investigation when performed by experienced doctors. All the Doctors performing these tests on patients referred by a GP and placed by the doctor (Colonoscopist) on a list at a Melbourne Endoscopy Group Day Hospital are Specialists at major teaching hospitals but none have any role in the day-to-day management of the BCPP. They advise the GP and may also advise the Specialist Medical Assessment Panel of the results which allows the BCPP to liaise with your GP regarding ongoing surveillance. Current expert opinion believes that surveillance colonoscopy is the best means of minimizing the risk of developing bowel cancer (estimates are by 75 to 90%). However, like all preventative measures, no methodology is fool proof. With any endoscopic procedure there are rare risks and complications that will be explained prior to the procedure. These risks include bleeding and perforation, either believed to occur in 1 out of 5000 procedures. This risk may increase if large polyps are found and removed.

Individuals for whom a colonoscopy is recommended and who wish to consider taking up this recommendation must consult a GP who may choose to refer you elsewhere in the health system or refer you to have a test by a specialist Colonoscopist who has procedure lists at a Melbourne Endoscopy Group Day Hospital. The Colonoscopist will then advise your GP and may advise the Specialist Medical Assessment Panel of the results, so the GP and the Panel can recommend appropriate ongoing surveillance.

The Colonoscopist will also explain the findings and discuss all relevant cancer prevention and related health issues with you following the procedure.

There are differences between the BCPP guidelines and those of the NH&MRC (2005). Our guidelines are, we believe, more up-to-date, are more proactive and are regularly updated to reflect changes in international research and opinion. These differences could be discussed with your General Practitioner who can access the websites as follows:
NH&MRC - www.health.gov.au
BCPP - www.bcpp.com.au

4. WHAT IF MY SPOUSE OR PARTNER IS INTERESTED IN THE PROGRAMME?

Due to the high incidence of bowel cancer in Australia, the Programme's medical team recommends spouse or partners also have access to this and subsequent information. This can be provided through these pamphlets or by telephoning the Programme's HELPLINE and speaking with a member of our staff.

5. ARE THERE COSTS INVOLVED IN THIS PROGRAMME?

For participants who complete the questionnaire and for whom no medical tests are required, there is no cost. For those who choose to have tests, as recommended by the Programme, routine costs of health care may be involved depending on where your GP refers you.

If your GP chooses to refer you to one of the colonoscopists who does procedures at one of the Melbourne Endoscopy Day Hospitals and you choose to follow this recommendation, the colonoscopy will result in routine Medical and Hospital charges. Most of the medical fees will be refunded by Medicare and Private Health Funds (if insured). Hospital charges are covered to varying degrees, depending upon an individual's level and type of Private Health Insurance. (The vast majority of insured individuals with Top Cover will have no out-of-pocket costs).

If you do not have Private Health Insurance, you may prefer, after discussion with your GP, to be referred to a public hospital waiting list for this procedure, which will be outside our prevention programme.

6. IF I'M INTERESTED, WHAT DO I DO?

Please read all the material provided and if you choose, please complete the Questionnaire and return it in the Reply Paid envelope. If your spouse or partner would like to participate in the Programme a second Questionnaire has been included for this purpose. The Programme will respond to all who return a Questionnaire and fall into a high risk group and recommend any action you should take. We stress the importance of discussing any questions or medical issues with your General Practitioner, particularly in regard to your suitability for a colonoscopy and the bowel preparation.

HELPLINE: If you have any questions regarding the BCPP, please contact us on (03) 9866 8899.

Remember, entry and participation in this Programme is entirely voluntary. All information is kept strictly private and confidential for each participant.