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Bowel Cancer Screening

Useful management information

For your patients, you are asked to:

  • encourage those who are sent a NBCSP screening test and for whom the test is clinically relevant, to participate.
  • assess those with a positive result and refer them for further examination as clinically indicated, for example a colonoscopy. The National Health and Medical Research Council (NHMRC) approved Guidelines state that participants with positive iFOBT results should have follow-up investigation unless there was a clear breach in protocol when samples were collected (e.g. menstrual blood loss close to the time of sample collection) and that colonoscopy should be performed as promptly as possible after a positive iFOBT to minimise the risk of psychological harm, although there is no evidence that prognosis is worsened within 120 days if cancer is present.
  • indicate whether a patient referred for colonoscopy is a NBCSP participant to assist with reporting to the Program Register.
  • notify the NBCSP of referral/non-referral for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the NBCSP GP Assessment Form by fax, post or electronically.
  • inform patients at average risk, or slightly above, that the NHMRC approved Guidelines recommend screening every two years, starting at age 50 years and continuing to age 74 years
  • manage patients identified as being at increased risk of bowel cancer in accordance with the NHMRC approved Guidelines.
  • manage patients (of any age) with symptoms in accordance with the NHMRC approved Guidelines, in recognition that bowel cancer can occur at any age.

Clinical Resources

National Bowel Cancer Screening website

Bowel Cancer screening for Aboriginal and Torres Strait Islander people

NHMRC: Clinical practice guidelines for surveillance colonoscopy

NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and/or value in repeat endoscopy/colonoscopy procedures

Minimum referral criteria Does your patient meet the minimum criteria?

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

  • iFOBT positive in patients ≥ 50-74 yeras old
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • A family history of colorectal cancer (CRC) in patients with either:
    • One first degree relative diagnosed with CRC ≤ 55 years old.
    • Two first degree relative diagnosed with CRC at any age.
    • One first degree plus at least two second degree relatives with CRC at any age.

NB: these relatives with CRC can be taken from both sides of the family i.e they do not have to be all on the same side.

  • Multiple bowel cancers

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for the referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information To be included in all referrals

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential referral information for Bowel Cancer Screening referrals

  • Patient and family history of bowel cancer e.g. relationship to patient, age of cancer diagnosis and type of cancer
  • U&E
  • Previous endoscopic procedures (date, report and histology)
  • For NBCSP patients with positive FOBT - include both NBCSP pathology report and ID number
     

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Bowel cancer screening referrals

  • No additional information 

Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Potentially life threatening symptoms suggestive of:

  • acute upper GI tract bleeding
  • acute severe lower GI tract bleeding
  • oesophageal foreign bodies/food bolus
  • Acute Severe Colitis*
  • bowel obstruction
  • abdominal sepsis
  • Severe vomiting and/or diarrhoea with dehydration
  • Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
  • Biliary sepsis (to be referred to a centre with ERCP service)

 

Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

  • temperature at presentation of > 37.8°C,
  • pulse rate at presentation of > 90 bpm,
  • haemoglobin at presentation of < 105 gm/l, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 19 December 2023
Last reviewed 4 May 2017