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Many patients to pay $1700 more for bowel cancer tests

Bowel Cancer Australia director Graham Newstead said the government’s decision to enforce a cut off age of 56 was “ridiculous”.

“Not all patients know exactly the age that dad has his bowel cancer,” Professor Newstead said.

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“What is the cut off of 56 years of age? This is nonsense. What they’re trying to say is a young person with bowel cancer may put their children at greater risk, but an older person doesn’t and 56 isn’t even old. I am not at all happy about a proscriptive and arbitrary decision that says if dad had bowel cancer at age 56 and half you’re not at increased risk. It simply makes no sense.”

Professor Newstead, who has done more than 60,000 colonoscopies, said people with a first degree history of bowel cancer have twice the normal risk of developing the disease.

Research also increasingly pointed to the disease being diagnosed in more young Australians. It is the second-most-common cause of cancer-related death in Australia.

From November 1, the federal government will enforce eight new strict Medicare item numbers to be used by specialists to determine whether a patient should undergo a colonoscopy in a move aimed at reducing unnecessary procedures.

Research has found significant variations in colonoscopy rates, with some pockets of Australia measuring 30 times the rate of the procedure when compared to others.

“The positives of this are that it really will help to minimise cowboys doing unnecessary and inappropriate colonoscopies,” Professor Newstead said. “I’m very supportive of any changes which control quality standards.”

The changes largely follow national guidelines which recommend screening for those with family members who have been diagnosed under the age of 55.

But leading Melbourne gastroenterologist Associate Professor Stephen Pianko said specialists have long used their own clinical judgement.

“Not all patients fit into boxes all the time so it makes it very difficult when you’ve got really regimented rules in place,” he said. “Patients who have siblings who have got this disease at 56 or 57 will understandably be very upset by this because the change in risk is so minimal.”

Associate Professor Pianko stressed, however, the changes do not affect people showing symptoms.

Research suggests about 90 percent of bowel cancers can be cured if detected early.

The current National Bowel Cancer Screening Program is freely available to Australians aged 50 to 74 every two years, but uptake for eligible people hovered at about 40 per cent and the faecal occult blood test was only about 70 per cent accurate.

A spokeswoman for the health department said the changes were consistent with national medical guidelines and followed extensive consultation with the Gastroenterological Society of Australia.

“The taskforce found that changes to colonoscopy services needed to be made to encourage best practice, improve patient care and safety,” she said.

The spokeswoman added that there would also be scope for patients with a high risk of colorectal cancer to get a Medicare-rebated colonoscopy, regardless of the age their relative was diagnosed.

One in 20 Australians will be diagnosed with bowel cancer by the age of 75. In 2018-19, more than 620,000 colonoscopies were claimed through Medicare.

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