31 July 2019.

A review of the benefits, costs and harms of Australia’s screening programs for bowel and cervical cancers has found they achieve a very strong ‘bang for the buck’, with bowel cancer screening costing as little as $3,380 for each year of life saved – far less than the threshold typically used to decide if medical treatments deserve public subsidies.

A paper just published in the latest issue of the Sax Institute’s journal Public Health Research & Practice (PHRP), is the first comprehensive review of the benefits, harms and cost-effectiveness of cancer screening in Australia, using the most up-to-date information.

Written by a team of experts including senior author Professor Karen Canfell, Chair of the Cancer Screening and Immunisation Committee, Cancer Council Australia, the paper finds that the bowel and cervical cancer screening programs are highly cost-effective, with bowel cancer screening having an exceptionally favourable benefit-to-harm balance. The paper says the National Bowel Cancer Screening Program costs $3,380 for each year of life saved, and that the National Cervical Screening Program – another strong performer – cost $16,632 for each year of life saved among women not vaccinated against human papillomavirus, compared to women who were not screened. Both of these figures are well below what the paper describes as the “indicative willingness-to-pay threshold” – $30,000 to $50,000 per life-year saved – used by Australian governments to tell which health programs represent a good use of finite health dollars.

However, the paper also finds further work is needed to provide updated and more comprehensive information on the benefits and harms of Australia’s BreastScreen program. An independent review published 10 years ago found BreastScreen Australia had cut breast cancer deaths by 21%–28% among women aged 50–69 years, but estimates of harms (such as overtreatment and overdiagnosis, which refers to cancers unlikely to have caused problems if undetected) were similarly outdated and were also derived from European reviews rather than work in Australia.

The paper is one of several looking at cancer screening in Australia and appears in a themed edition of PHRP that was supported by and developed in partnership with Cancer Council Australia and Cancer Institute NSW. Other articles explore a range of topics on this theme, from ways to increase participation in the bowel screening program to new approaches and technologies to improve breast screening.

A perspective series of articles looks at the state of play and potential for screening for skin, lung, liver and prostate cancers, as well as for the genetic condition Lynch syndrome, which predisposes carriers to colorectal and other cancers.

The papers suggest there may be opportunities to prevent thousands of deaths through targeted screening for melanoma and lung cancer, systematic testing for Lynch syndrome and organised surveillance for hepatocellular carcinoma in people at high risk, although population-wide screening for these conditions is not currently warranted.

These papers come just as the Federal Minister for Health, Greg Hunt, has ordered a fresh look at lung cancer screening, announcing a new inquiry into its feasibility.

In an editorial, Professor Sanchia Aranda, CEO of Cancer Council Australia and Professor David Currow, CEO of the Cancer Institute NSW, state that while emerging knowledge of risk factors for different cancers opens the door to new risk-stratified approaches to screening, this will make both the system and the messaging to the public more complicated.

Other articles find that:

  • Simulation modelling could play a key role in identifying the harms and benefits of population screening policies.
  • GP endorsement may be one of the most effective ways to boost low levels of participation in the National Bowel Screening Program
  • We need to address screening inequities if we are to eliminate cervical cancer as a public health threat by 2040

PHRP is Australia’s first online-only open access peer-reviewed public health journal, with a strong focus on connecting research, policy and practice.

Researchers are welcome to submit manuscripts and encourage their colleagues to submit. You can also subscribe to receive quarterly e-alerts when the journal is published, make suggestions about themes or topics for future issues, and follow us on Twitter @phrpjournal