Poorer Australians at Risk of Bowel Cancer Missing Out on Colonoscopies, While Affluent Areas See Overuse
Poorer Australians at risk of bowel cancer are missing out on colonoscopies needed to diagnose the condition, while people in the most affluent areas are returning for repeat procedures too soon, contrary to clinical guidelines. A new analysis of Medicare and ABS data reveals a growing divide along socioeconomic and geographical lines, as public waiting lists for colonoscopies blow out in areas of greatest need.
Updated clinical guidelines released on Sunday by the Australian Commission on Safety and Quality in Health Care aim to emphasise which patients should be referred for colonoscopy, and when. The guidelines also seek to address poor communication, which has exacerbated diagnosis delays for some patients, while others are being over-investigated.
Disparities in Colonoscopy Rates Across Australia
The Commission’s new Atlas Focus Report: Colonoscopy, also released on Sunday, shows the colonoscopy rate in major cities was four times higher than in remote areas (2,550 versus 633 per 100,000 people) in 2023-2024. Limited resources and workforce shortages play a clear role in lower colonoscopy rates outside metropolitan areas.
“We’re also seeing this disparity growing between affluent and disadvantaged areas over the decade, where rates rose by 8% in the most advantaged areas and declined by 13% in the most disadvantaged areas,” said Sydney GP Dr Phoebe Holdenson Kimura, the Commission’s medical adviser.
Areas in the highest socioeconomic quintile had nearly double the colonoscopy rate of those in the lowest quintile (3,067 compared with 1,675 per 100,000 people). The 10 areas with the highest colonoscopy rates in NSW were all affluent parts of Sydney, led by Eastern Suburbs North (4,383 per 100,000 people), with a rate 3.12 times that of socioeconomically disadvantaged Mount Druitt (1,252 per 100,000).
In Victoria, Bayside had the highest colonoscopy rate (4,321 per 100,000), more than 2.12 times that of the Tullamarine-Broadmeadows area.
Early Repeat Colonoscopies Raise Questions
Meanwhile, the NSW and Victorian areas with the highest colonoscopy rates almost completely overlapped with the highest rates of colonoscopies performed within three years of a patient’s previous procedure. According to national guidelines, only a small proportion of people need such frequent colonoscopies, suggesting many are being inappropriately performed too soon.
Nationally, the rate of early repeat colonoscopies fell by 8% in the decade to 2023-2024. However, in affluent areas, it rose by 2%.
Conjoint Professor Anne Duggan, the Commission’s chief executive and a gastroenterologist, said: “It makes you wonder: are people having colonoscopies that they don’t need? Are people who need them not getting them, and why?”
Personal Story Highlights Systemic Challenges
Cameron Sew Hoy knows he waited too long to see his GP in 2019. For five weeks, his bowel movements had been painful, and he had noticed blood in his stools. “The first thing my GP said was, ‘At least it’s not cancer,’ given my age,” Sew Hoy, 42, recalled.
He was initially diagnosed with colitis, but medication had no effect, and the gastroenterologist scheduled a colonoscopy. “When I woke up, he told me that I had a tumour.” Sew Hoy was diagnosed with stage three colorectal cancer.
He is among a growing number of young people not eligible for the free bowel screening test who are being diagnosed with bowel cancer.
Sew Hoy underwent surgery to remove the tumour and part of his colon, followed by 12 rounds of chemotherapy. “At the time, it was the most difficult thing I had ever experienced,” he said. “My daughter, Charlotte, would have been about two years old at the time.”
Now in remission, his follow-up care includes a colonoscopy every three years. But the process has not been straightforward.
When he realised his next colonoscopy was due earlier this year, he spoke to his surgeon’s receptionist, who told him there was a backlog of patients. One month after the procedure, his GP had not yet received the results. “Communication could be better,” he said. “Ideally, this should be a smooth process, but it doesn’t appear to be so.”
Colonoscopies Key to Bowel Cancer Prevention and Detection
About 968,000 colonoscopies are performed in Australia each year to prevent and detect bowel cancer, the fourth most common cancer diagnosed nationally. Almost 90% of cases are diagnosed in people aged over 50.
Colonoscopy is recommended for people whose national bowel cancer screening test returns a positive result, those with key symptoms (such as rectal bleeding, change in bowel habits, or unexplained weight loss), and people with a strong family history of bowel cancer.
People aged 50 to 74 are sent a bowel screening test every two years as part of the program, and those aged 45 to 49 can request a free screening kit. However, only two in five eligible people participate.
Waiting Times and Access Inequities
Holdenson Kimura stressed the importance of ensuring people are not getting colonoscopies too soon, as this could affect waiting times for those with positive screening results who need the procedure within a month.
Patients at Sydney’s Westmead Hospital wait up to a year for colonoscopies after a positive bowel cancer screening test. In Victoria, patients face waits of up to nine months.
Duggan said that, if the system were designed to respond to the greatest need, more colonoscopies would be performed in lower socioeconomic areas where bowel cancer rates and deaths are higher.
Victoria’s Highest Colonoscopy Rates (per 100,000 people)
- Bayside – 4,321
- Stonnington East – 3,918
- Glen Eira – 3,634
- Kingston – 3,604
- Boroondara – 3,500
- Manningham East – 4,390
- Stonnington West – 3,473
- Mornington Peninsula – 3,397
- Keilor – 3,356
- Nillumbik Linglake – 3,305
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