title: Survival impact of the Australian National Bowel Cancer Screening Programme.
abstract: BACKGROUND
  The Australian National Bowel Cancer Screening Program (NBCSP) has been offering age-based faecal occult blood testing since 2006. With the rapid expansion of this programme, the NBCSP will ultimately offer biennial screening to all 50-74 years old by 2020. Participation rates remain low. Previous reports have described an increased proportion of earlier stage cancers in patients with NBCSP-detected tumours.
  
  
  METHODS
  Data on consecutive patients enrolled into a prospective, comprehensive, multidisciplinary database at six Victorian hospitals were examined. Clinicopathologic and outcome data were compared for NBCSP and symptomatic presentation patients.
  
  
  RESULTS
  We identified 3743 patients that presented with colorectal cancer (CRC) at participating hospitals since May 2006. Of 1930 patients aged between 50 and 70 years, 141 (7.3%) had a NBCSP detected cancer, 1441 (74.7%) presented with symptoms and 266 (13.8%) were diagnosed through screening outside of the NBCSP. Based on the American Society of Anaesthesiology score, the NBCSP patients were fitter. They had an earlier stage of diagnosis and were more likely to be female and less likely to have lymphovascular invasion or to present as an emergency. NBCSP detected patients had a lower rate of recurrence (HR 0.17, P = 0.0001) and fewer deaths (HR 0.19, P = 0.005).
  
  
  CONCLUSIONS
  Patients with NBCSP-detected CRC have a markedly reduced risk of CRC recurrence and death compared with patients with a symptomatic presentation. The dominant driver of this appears to be earlier stage at diagnosis. Increased promotion of the impact of the NBCSP, including data related to the survival impact, should be undertaken to increase participation rates and achieve further survival gains.
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Ananda
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Research, Walter and Eliza Hall Institute,, Melbourne, Victoria, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Faragher
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: I T
authors.initials: IT
authors.lastname: Jones
authors.affiliation: Department of Surgery, Eastern Health- Box Hill Hospital, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Steele
authors.affiliation: Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kosmider
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Research, Walter and Eliza Hall Institute,, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Desai
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.|Research, Walter and Eliza Hall Institute,, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Tie
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Field
authors.affiliation: Department of Surgery, Eastern Health- Box Hill Hospital, Melbourne, Victoria, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.|Research, Walter and Eliza Hall Institute,, Melbourne, Victoria, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Tran
authors.affiliation: Research, BioGrid Australia, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Bae
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.|Research, Walter and Eliza Hall Institute,, Melbourne, Victoria, Australia.|Research, BioGrid Australia, Melbourne, Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Gibbs
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D055088:Early Detection of Cancer / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: colorectal cancer; screening; survival