What can we learn from high-performing programs to increase bowel cancer screening participation in Australia?

Only 33% of those approached for the first time by the Australian National Bowel Cancer Screening Program between 2018 and 2019 returned the kit. This paper reviews methods to increase participation rates..

Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation.

Methods: We searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening.

Results: National programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features.

Conclusions: Apart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation.

Impact: This screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.


Louisa Flander, Evelien Dekker, Berit Andersen, Mette Bach Larsen, Robert J Steele, Nea Malila, Tytti Sarkeala, Manon van der Vlugt, Clasine de Klerk, Bart Knottnerus, Lucinda Bertels, Anke Woudstra, Manon C.W. Spaander, Mirjam Fransen, Sirpa Heinavaara, Mary Dillon, Driss Ait Ouakrim, and Mark Jenkins

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