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Author version made available in accordance with the publisher's policy., Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, and an ideal target for early detection and prevention through cancer screening. Unfortunately, rates of participation in screening are less than adequate. In this article we explore why people who were offered a fecal immunochemical test for CRC decided to participate or not, and for those who did participate, what influenced them to take action and complete the test. We conducted four focus groups and 30 telephone interviews with 63 people. The main reason people decided to screen was “wanting to know” their CRC status, which operated on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of participants expressed ambivalence about CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced., National Health and Medical Research Council Project Grant (#593505)

Published version made available with permission of the publisher., BACKGROUND: This paper sought to determine the status of older Australians with regard to Bowel Cancer screening practices occurring outside of the National Bowel Cancer Screening Program. METHOD: A random sample of N=25,511 urban Australians aged 50 to 74 years received a questionnaire via mail asking questions relating to bowel screening. N=8,762 (34.3%) returned a completed questionnaire. RESULTS: Approximately 33% (N=2863) of respondents indicated they had undergone colonoscopy in the preceding five years and 21% (N=1840) had used a Faecal Occult Blood Test (FOBT) in the preceding 12 months. Furthermore, 27% (N=497) of those who had completed an FOBT had also undergone colonoscopy. CONCLUSION: A significant proportion of older Australians might be participating in bowel screening practices outside of the national program (NBCSP). Moreover, the proportion of individuals reporting use of both FOBT and endoscopic services is much higher than the positivity rate of FOBT. Large population FOBT screening programs, such as the NBCSP, that do not consider participation in screening external to the program may underestimate true population screening rates., This project was supported by the National Health and Medical Research Council of Australia: Grant #593505.

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

The early detection of colorectal cancer (CRC) is a major clinical and public health concern. CRC is now the second most commonly diagnosed cancer in Australia and has the second highest cancer mortality rate. Around 1 in 19 men and 1 in 28 Australian women will develop the disease before 75 years of age. In 2005 there were 4165 deaths from CRC in Australia, accounting for almost 11% of all cancer deaths. Cancer mortality rates vary according to the remoteness of a person’s place of residence. The average annual death rate for CRC during 1998–2001 in Australia was highest in inner and outer regional areas (13.4% and 13.3%), followed by major cities (12.8%), remote areas (12.4%) and very remote areas (7.7%). Survival is inversely related to the degree of cancer progression, and up to 90% of all deaths from CRC may be preventable with early detection. This study aimed to explore the association between screening participation and different sociodemographic indicators in SA. This was part of a broader study that included a qualitative exploration of the barriers to and facilitators of NBCSP participation among selected ethnic groups, Indigenous Australians and people who speak English at home. This paper also draws on these qualitative findings in discussing the uptake of screening in rural, remote and metropolitan areas of SA.

The National Bowel Cancer Screening Program (NBCSP) is a population-based screening program based on a mailed screening invitation and immunochemical faecal occult blood test. Initial published evidence from the NBCSP concurs with international evidence on similar colorectal cancer screening programs about the unequal participation by different population sub-groups. The aim of the paper is to present a cross-sectional analysis of participation in the NBCSP for Adelaide, in order to identify geographical areas and population groups which may benefit from targeted approaches to increase participation rates in colorectal cancer screening.