1 July 2020

Read our Q&A with Dr Ginni Mansberg as she answers your questions about bowel screening and the next steps if you need a colonoscopy.

Can my doctor offer me an at-home screening test if I am healthy and under 50?

The short answer is yes, but it’s not quite that simple. Bowel cancer in people under 50 is uncommon, and you GP will be conscious of not subjecting you to unnecessary tests.

The guidelines for screening in Australia were updated a few years ago and now include a consensus-based recommendation for a GP to offer the at-home test every two years to people aged 45–49 years who request screening after informing them of the benefits and harms of testing.

The benefits are easy – screening detects bowel cancer early at a stage when it is easier to treat. But there are potentially adverse effects of screening too, including distress and anxiety associated with a false positive result and perforation of the bowel during colonoscopy (about 1 in 1000 patients). However, the positives are likely to outweigh the negatives.

If you are under 45 and otherwise healthy, by all means have a chat with your GP about screening. If it’s important to you after discussing the facts you can request a test from your GP, purchase one from a pharmacy or even online.

Of course, if you are experiencing symptoms or have a family history of bowel cancer or polyps, you should always have a chat to your GP about it no matter how old you are.

Can I request a colonoscopy without having taken an at-home bowel screening test?

In some cases you can be referred for a colonoscopy without having taken an at-home bowel screening test, known as a faecal occult blood test (FOBT).

Most people aged over 50 have an average risk of developing bowel cancer. Medical guidelines in Australia recommend the at-home screening test from age 50 and every two years after that. Once you turn 50 you are eligible for the Government’s free bowel screening test sent to all Australians every two years from age 50 to 74.

If your result is positive, the next step is a follow up colonoscopy to investigate the underlying cause which can be anything from nothing (test results can be false) to bowel cancer, the least likely.

If you are in a higher risk category – say you have seen blood in your poo or you have had polyps removed from your bowel before – it is important to rule out anything sinister, so your GP will refer you straight to colonoscopy.

Another reason your GP might refer you for a colonoscopy is if there is a history of bowel cancer or polyps in your family that increases your risk – so you might have a first-degree relative who was diagnosed with bowel cancer before the age of 55; or two first or second-degree relatives diagnosed with bowel cancer on the same side of the family, of any age. If this is you, your GP can advise you about bowel screening that is right for you and that age you should start screening.

What should I do if I am experiencing ongoing symptoms and my GP does not refer me for colonoscopy?

It is important to be aware of the symptoms of bowel cancer and to speak to your GP if you think something’s not quite right. The Jodi Lee Bowel Cancer Foundation has a symptom checker on its website, backed by research conducted at Curtin University – here – to help you assess the severity of your symptoms.

Bowel symptoms are super common and can be a sign of something serious like bowel cancer or less serious like irritable bowel syndrome. Firstly, it’s important to rule out anything serious like inflammatory bowel disease or cancer by conducting a number of tests, one of which may be colonoscopy.

Depending on your age and your symptoms, your GP may be hesitant to refer you for colonoscopy. If you are under 50 your GP will often think there is no need to rush into a whole load of tests, because 91% of bowel cancers are diagnosed in people over 50. However, if you feel your GP is not listening to you, push a little harder and if you still don’t get anywhere you may want to consult another doctor.

Can I choose the specialist I am referred to for a colonoscopy?

Yes and no. Generally, you can choose to be referred to a public hospital or to a specialist in private practice.

If you choose a public hospital you will be assigned a specialist to perform the colonoscopy. The procedure is free apart from a small cost for the bowel preparation, but you might have to wait a while depending on urgency and patient demand.

If you have private health insurance you can still choose to have your colonoscopy performed at a public hospital at little or no cost. You may be able to select your specialist but you will still be placed on the waiting list.

Anyone can choose to have a colonoscopy performed thorough a private practice, which allows you to select your specialist and book a time that suits you. It is likely your private health insurer will pay benefits towards most (but not all) of the cost of your colonoscopy. If you do not have private health insurance you will need to cover a large portion of the costs yourself.

What should I do if the specialist I am referred to is too expensive or has a long waiting list?

Let’s say your at-home screening test result was positive and your GP has referred you for colonoscopy. In this scenario, ideally your procedure will be performed within 120 days. If the hospital or specialist you were referred to cannot perform your colonoscopy within this timeframe, and that doesn’t suit you, then you might want to reconsider your options. The same applies if you are unhappy about the out-of-pocket costs for the procedure. Ask around to see if someone you know can recommend a specialist, make some calls and speak to your GP about referring you to someone else or another hospital that might suit you better.