Colorectal cancer screening in Australia: a community-level perspective

Objectives: To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines at a community level. Setting: A cross-sectional cohort of at-risk people aged 56–88 years randomly selected from the Hunter Community Study (HCS), Australia. Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening rates for each CRC screening modality; level of screening in accordance with national screening guidelines. Results: Of the 1117 participants (70%) who returned a questionnaire, 777 were deemed asymptomatic and eligible for analysis. Overall, 63% of respondents had ever received any CRC testing. Forty-three per cent had ever had a faecal occult blood test (20% screened in the previous 2 years); 30% had ever had a colonoscopy (16% screened in the previous 5 years); and 7% had ever had a sigmoidoscopy (1% screened in the previous 5 years). Rates of adherence to screening guidelines were 21% for respondents who were at or slightly above average risk, and 45% for respondents who were at moderately increased or potentially high risk. Conclusions: Rates of CRC screening remain low. The screening rate for colonoscopy was particularly high among people who were at or slightly above average risk, despite such screening not being endorsed in the guidelines. Effective strategies to improve rates of CRC screening and appropriate use of colonoscopy are required across the entire at-risk population.