Are Australian general practice patients appropriately screened for colorectal cancer? A cross-sectional study

Background: Australia has one of the highest rates of colorectal cancer (CRC) in the world. Data from the National Bowel Cancer Screening Program (NBCSP) suggests that only one third of Australians eligible for CRC screening are up-to-date with CRC screening; however screening occurring outside the program is not captured. Aims: This study examines the self-reported CRC screening practices of general practice patients, and the factors associated with being under-screened for CRC. Methods: A cross-sectional study conducted in five general practice clinics in NSW from 2015-2017. Participants were aged 50-75 and at average risk of CRC. Participants reported whether they had a faecal occult blood test (FOBT) in the past two years, including the source of FOBT; and whether they had a colonoscopy in the past five years and the reason for colonoscopy. Results: Forty-nine per cent of participants completed a FOBT in the past two years. Of these, 62 per cent sourced their FOBT from the NBCSP and 25 per cent from their general practitioner. Thirty-seven per cent of participants reported colonoscopy in the past five years. Of these, 29 per cent received potentially inappropriate colonoscopy. Thirty-two per cent of the samples were classified as under-screened. Older adults were less likely to be under-screened. Conclusion: CRC screening rates were higher than those reported by the NBCSP, however a significant proportion of participants remain under-screened. Over one-quarter of participants reporting colonoscopy in the past five years may have undergone unnecessary colonoscopy. These findings indicate that more needs to be done at a general practice level to facilitate risk-appropriate CRC screening.