title: Optimising the expansion of the National Bowel Cancer Screening Program.
abstract: OBJECTIVE
  To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact of the expansion scenarios on colonoscopy demand.
  
  
  METHODS
  MISCAN-Colon, a well established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50-year period, starting in 2006. The model parameters included rates of participation in screening and follow-up, rates of identification of cancerous and precancerous lesions, bowel cancer incidence, mortality and the outcomes of the NBCSP. Five implementation scenarios, based on biennial screening using an immunochemical faecal occult blood test, were developed and modelled. A sensitivity analysis that increased screening participation to 60% was also conducted.
  
  
  METHODS
  Australian residents aged 50 to 74 years.
  
  
  METHODS
  Comparison of the impact of five implementation scenarios on the number of bowel cancer deaths prevented and demand for colonoscopy.
  
  
  RESULTS
  MISCAN-Colon calculated that in its current state, the NBCSP should prevent 35 169 bowel cancer deaths in the coming 40 years. Accelerating the expansion of the program to achieve biennial screening by 2020 would prevent more than 70 000 deaths. If complete implementation of biennial screening results in a corresponding increase in participation to 60%, the number of deaths prevented will increase across all scenarios.
  
  
  CONCLUSIONS
  The findings strongly support the need for rapid implementation of the NBCSP. Compared with the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths (about 35 000) being prevented in the coming 40 years.
authors.affiliation: Education and Research, Cancer Council Western Australia, Perth, WA, Australia. dcenin@cancerwa.asn.au.
authors.forename: Dayna R
authors.initials: DR
authors.lastname: Cenin
authors.affiliation: Cancer Prevention Centre, Cancer Council Victoria, Melbourne, VIC, Australia.
authors.forename: D James B
authors.initials: DJ
authors.lastname: St John
authors.affiliation: Education and Research, Cancer Council Western Australia, Perth, WA, Australia.
authors.forename: Melissa J N
authors.initials: MJ
authors.lastname: Ledger
authors.affiliation: Cancer Council Western Australia, Perth, WA, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Slevin
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003198:Computer Simulation; D055088:Early Detection of Cancer; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends