40 HOW TO TREAT : SCREENING COLONOSCOPY HALVES COLORECTAL CANCER MORTALITY
40 HOW TO TREAT : SCREENING COLONOSCOPY HALVES COLORECTAL CANCER MORTALITY
14 MARCH 2025 ausdoc . com . au
PAGE 38 and polypectomy .
life-extending colonoscopy
Federal Department of Health and Aged Care and the MBS
To facilitate the funding and provision of colonoscopy and colonoscopic polyp ectomy in Australia , the MBS lists various item numbers for therapeutic procedures . 20 These MBS item numbers ( 32222 to 32229 ) now provide the specific funding for patients , colonoscopists and their institutions across Australia to provide for screening colonoscopy ( see figures 7-10 ).
However , and somewhat confusingly , it should be noted that the MBS item numbers 32224 , 32225 and 32226 refer to moderate and high-risk patients , and that these moderate and high-risk definitions differ to the aforementioned Cancer Council Australia Category 2 and Category 3 definitions . Therefore , the authors recommend that GPs learn and adopt these four flowcharts in clinical practice , as these specific MBS item numbers determine the exact funding available and therefore in turn the exact management of these different groups of patients .
Australian Commission on Safety and Quality in Health Care and the Colonoscopy Clinical Care Standard
The Australian Commission on Safety and Quality in Health Care ’ s Colonoscopy Clinical Care Standard encourages all facilities and clinicians delivering colonoscopy services to provide colonoscopy to an agreed high standard . This includes a timely copy of the colonoscopy report and histology result to the patient and their GP . 21
Many colonoscopists are now taking advantage of the recent improvements in software and practice management software ( for example , Medical-Objects ) that now facilitate immediate forwarding of colonoscopy reports ( including colour photography ) through to the referring GP . Compliance with the Colonoscopy Clinical Care Standard is mandatory under the Australian Health Service Safety and Quality Accreditation Scheme ( MBS TN . 8.152 ). 9
Royal Australian College of General Practitioners ’ Red Book
MBS Online states : “ When colonoscopy is considered clinically appropriate , general practitioners should ensure colonoscopy referral practices align with applicable national guidelines , including the Royal Australian College of General Practitioners ’ Guidelines for Preventive Activities in General Practice ( the Red Book )”. 9
The recently published 10th edition of the Red Book states that “ due to the potential harms of colonoscopy and additional costs to the health system of this procedure , colonoscopy is only recommended as a screening test for people who are at least at moderate risk of colorectal cancer ”. 22
Again , the authors argue that the aforementioned NordICC and UKFSST Level 1A evidence should now be guiding the advice we give patients on the colorectal cancer
MBS 32228 Normal ( or Low ) Risk Once Per Patient Lifetime Screening Colonoscopy Pathway . Anyone , any age , subject to the clinician ’ s opinion that there is a clinical need for a colonoscopy
Normal
Join NBCSP four years later with FOBT , then FOBT every two years until 74
screening modalities available to them , thus empowering patients to make their own informed decisions about the potential benefits and harms of colonoscopy and in turn make an informed choice about their own access to screening colonoscopy .
Victorian Government Department of Health
The Victorian Government Department of Health has recently developed
Screening colonoscopy
Adenomatous polyp ( s )
Polypectomy then repeat colonoscopy in time interval ( 1 , 3 or 5 years ) depending on number and type of polyps
• This MBS category can be used for family history normal ( or low ) risk patients ( based on NordICC and UKFSST Level 1A evidence ).
• This can be used for anyone who could benefit from a once per patient lifetime screening colonoscopy who is ineligible for a screening colonoscopy under MBS items 32222 to 32226 .
• Suggest age range of 45-74 .
Figure 7 . MBS 32228 Normal ( or Low ) Risk Once Per Patient Lifetime Screening Colonoscopy Pathway .
a program to train nurses to become nurse endoscopists . A nurse endoscopist is an advanced practice specialised nurse trained under the direct supervision of gastroenterologists and colorectal surgeons to perform endoscopic examinations . Nurses are currently required to complete five years of clinical experience as a registered nurse , three years of nursing experience within the gastroenterology specialty , including two years ( concurrent ) experience in endoscopy , as well as a
Abnormal
Colorectal cancer
Treatment
MBS 32222 Normal ( or Low ) Risk Two Yearly FOBT Screening Colonoscopy Pathway NBCSP FOBT – sent to patients every two years from age 50 to 74 ( from July 2024 , patients 45 and older can request a kit be sent to them )
Negative
Repeat FOBT every two years until 74
Return to NBCSP via repeat FOBT four years later
No polyps ( Approx 50 % of FOBT positive patients )
FOBT
Positive
Screening colonoscopy
Polyp ( s ) ( Approx 45 % of FOBT positive patients )
Polypectomy then repeat colonoscopy in time interval ( 1 , 3 or 5 years ) depending on number and type of polyps
Figure 8 . MBS 32222 Normal ( or Low ) Risk Two Yearly FOBT Screening Colonoscopy Pathway .
Colorectal cancer ( Approx 5 % of FOBT positive patients )
Treatment
• Screening colonoscopy should be offered to family history normal ( or low ) risk patients returning a positive FOBT ( either through GP referral or via the NBCSP ), using MBS item number 32222 . relevant postgraduate qualification . The Australian College of Nurse Practitioners currently provides ongoing support for the fledgling numbers of Australian nurse colonoscopists .
A formalised training program was recently provided by the State Endoscopy Training Centre ( SETC ), through Austin Health in partnership with the Victorian Department of Health . 23
The authors ’ view is that the largest reduction in colorectal cancer mortality will only occur across Australia
Box 4 . Cancer Council Australia risk guidelines for colorectal cancer screening
• Category 1
— An individual should be advised that their risk of developing colorectal cancer is :
• Near average risk if they have no family history of colorectal cancer ( no firstdegree or second-degree relatives ).
• Above average but less than twice the average risk if they have only one first-degree relative with colorectal cancer diagnosed at age 60 or older .
• Category 2
— An individual should be advised that their risk of developing colorectal cancer is at least two times higher than average , but could be up to four times higher than average , if they have any of the following :
• Only one first-degree relative with colorectal cancer diagnosed before age 60
• One first-degree relative AND one or more second-degree relatives with colorectal cancer diagnosed at any age .
• Two first-degree relatives with colorectal cancer diagnosed at any age .
• Category 3
— An individual should be advised that their risk of developing colorectal cancer is at least four times higher than average , but could be up to 20 times higher than average , if they have any of the following :
• Two first-degree relatives AND one second-degree relative with colorectal cancer , with at least one diagnosed before age 50 .
• Two first-degree relatives AND two or more second-degree relatives with colorectal cancer diagnosed at any age .
• Three or more first-degree relatives with colorectal cancer diagnosed at any age .
Source : Cancer Council Australia 2023 19
when there are sufficient numbers of both nurses and doctors performing screening colonoscopy and polypectomy to remove the large volume of precancerous colorectal polyps that is required to bring down the current colorectal cancer mortality rate .
Australian open access colonoscopy clinics
Open access ( also called rapid access , or direct access ) colonoscopy clinics are being rolled out across metropolitan and regional Australia . These dedicated clinics focus on the provision of high volume and high quality colonoscopic services for their local communities . They have many advantages for both GPs and patients , as these clinics can reduce wait times for a