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Professor Stephen Halloran: NZ's bowel screening programme is up to scratch

Published on 31 July 2017 back to previous

By Stephen Halloran

New Zealand's bowel screening programme is worth celebrating. As someone who specialises in screening for colorectal cancer, I think it is tremendous that your country has made the decision to implement a national bowel screening programme, and that this is now getting under way.

New Zealand's bowel cancer rates are some of the worst in the world, with about 1200 men and women dying from it every year.

In the lead up to New Zealand launching its bowel screening programme and over the past two weeks, I've been surprised to read some of the comments being made. These include suggestions that the programme is somehow not up to scratch, and anger that the starting age is not lower.

Setting up a population based screening programme is no mean feat. Real care must be taken to balance the benefits and risks, for participants and for those requiring access to the same health services who are outside the screening programme.

I have seen many national bowel cancer screening programmes that have been implemented on a wave of enthusiasm, media euphoria and political capital.
If they have not been planned carefully, with realistic assessment of current resources or quality, if they have not been piloted thoroughly to fully understand the nuances of effective organisation, clinical provision and likely outcome, then, with very few exceptions they hit the rocks.

Perhaps the most important element of a bowel cancer programme is to ensure that the referral rate to further investigation (usually colonoscopy) matches the available resource, a resource which is of high quality, monitored carefully giving proof of that quality. This is what your country is doing.
New Zealand is starting with a population at higher risk than most others and with a limited, but growing, colonoscopy resource.

It is therefore imperative to commence screening with an age group that carries the highest risk - in this case those aged 60 to 74 - and it is also rational to roll the programme out gradually as you receive evidence that service provision in individual areas meets specified quality standards.
Your programme has the hallmark of quality, thorough research, detailed planning, meticulous preparation and a focus on ease of access and equity for the population at most risk.

Well-designed programmes, like New Zealand's, can grow in time to make the most of growing healthcare capacity.
New Zealand has applied a highly professional approach to developing its screening programme. Short-term fixes rarely work. I'm very pleased that your country has taken the long-term perspective and it will now begin to see the benefits.

Celebrate your bowel screening programme, and even more importantly, when you get sent your screening kit, do the test.
This is a cancer that, in the majority of cases, can be successfully treated when detected at an early stage. There is no argument about the fact that bowel screening saves lives.
(Bowel screening is for people who don't have symptoms of bowel cancer. If you develop any symptoms of bowel cancer, it is important that you talk to your doctor. Information on the National Bowel Screening Programme is available at

• Professor Stephen Halloran is based in England where he developed and directed the NHS bowel cancer screening programme from its inception in 2006 until his retirement in 2015. He is an adviser to New Zealand's national bowel screening programme.
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