FREW, Mr Charles William, Director, Bowel Cancer Australia, Principal petitioner

WIGGINS, Julien Grant, Chief Executive Officer, Bowel Cancer Australia

Committee met at 10:00

CHAIR ( Mr Murphy ): I declare open this public hearing of the Petitions Committee. I welcome all witnesses and members of the public to the hearing today, where we will discuss selected petitions. Under the rules of the House of Representatives, the Petitions Committee is required to consider whether petitions comply with those rules. If so, the petition may then be presented to the House and the committee may refer it to the relevant government minister for a response. We may also hold public hearings into petitions, allowing both principal petitioners and government agencies to consider further the concerns raised in petitions and the response made, and that is what is happening today. The committee itself does not seek to follow up individual petitions but rather these hearings enable a forum to bring a matter to the attention of relevant ministers and interested parties. It is important to note that the committee does not make recommendations to government arising from these hearings. A copy of the Hansard transcript will be sent to the relevant minister for their information.

Today we expect to hear from the principal petitioners or their representatives for the following petitions: a petition on the National Bowel Cancer Screening Program, which we will consider first, a petition on the Trans-Pacific Partnership free trade agreement talks, followed by a petition on flight crew ratios under civil aviation laws and finally a petition on the disclosure by financial institutions of customer information held offshore.

So that we can be clear about the procedures that the committee will follow today, I will outline them briefly now. I will invite witnesses to come to the table in turn to answer our questions. As you can all see, the committee's proceedings are being recorded by Hansard.

National Bowel Cancer Screening Program

[10:04]

CHAIR: I welcome our first witnesses, Mr Frew and Mr Wiggins. Although the committee does not require you to give evidence under oath, I should advise you that the hearing today is a formal proceeding of our parliament. I remind you, as I remind all witnesses, that the giving of false or misleading evidence is a serious matter and may be regarded as a contempt of parliament. Do you have any comments to make on the capacity in which you appear today?

Mr Frew : I am a non-executive director of Bowel Cancer Australia and I was the principal petitioner of the petition to raise awareness of bowel screening in Australia.

CHAIR: Before we ask you questions, would you like to make an opening statement for the benefit of the committee?

Mr Frew : Ladies and gentlemen, thank you very much for the opportunity to come here today to discuss this national-screening program. Bowel Cancer Australia is a charity with a mission to decrease the incidence of bowel cancer in our community. We are involved in advocacy, awareness, education, patient support and research. Annually throughout Australia, 14,000 Australians are diagnosed with bowel cancer and, sadly, on current numbers, we lose around 4,000 of them. It is the second largest cancer killer in this country. Put simply: a bowel-screening program saves lives.

The premise of the petition remains as relevant today as it did two years ago—namely, in three areas. First of all, Australia lacks a comprehensive bowel-screening program that offers screening to people aged 50 and over at least every two years. We also need a public awareness education program to run with that to promote the benefits of the screening program. Throughout our community unnecessary deaths continue from what is essentially a preventable disease. South Australian data showed that with early detection we have an 88 per cent success rate.

The brief background to the petition is we were approached by a Bowel Cancer Australia supporter whose mother had been diagnosed with bowel cancer. Regretfully, it was in the liver, so it was in the late stages. As a director and a cyclist I undertook to take on this petition with her and on her behalf. I have seen the firsthand impact of bowel cancer diagnosis and I am also part of the volunteer public awareness campaign that we run called A Healthy Community, where we lecture communities and corporates on the screening program as it exists at the moment. I am passionate about making a difference by ensuring that the NBCSP is expanded to include everyone aged 50 and over.

The petition was started at the time when the national bowel-screening program was lapsing and funding was to cease on 30 June 2011. The petition was one way we could demonstrate a need for such an important lifesaving program. We raised over 5,000 signatures in what was a very short period of time. I led a ride to Canberra with a number of supporters to deliver the petition to the shadow federal minister for health and ageing on behalf of Bowel Cancer Australia.

CHAIR: I understand that you are aware that the committee met with officers from the Department of Health and Ageing in Canberra on 20 March to discuss this petition, the response to it and any updates since the petition received a response in February 2012.

Mr Frew : Yes.

CHAIR: The committee is interested to know why Australia has one of the highest rates of bowel cancer in the world. Against that background, can you briefly discuss the possible reasons for this and what puts people in the high-risk category for developing bowel cancer?

Mr Frew : I can speak on my own behalf. I do not wish to state for the record any statistics that I do not have the references to back up. I can speak primarily in my role as a volunteer awareness lecturer. I essentially see an increase in lifestyle changes that are, quite frankly, a concern not just for bowel cancer but for coronary heart disease, type II diabetes and other diseases. I talk obviously about exercise, diet and everything related to that.

There is an extraordinary lack of awareness about health in general in the groups of people we lecture to. We lecture to a very broad segment of the community. I am happy to put on record that we have collectively done around 140 of these public appearances in the last four to five years. They have been as broad as from mines to factories, corporations—what used to be referred to as white- and blue-collar industries—as well as the prison system, including the officers and health workers within the prison system and the inmates. They are very diverse community groups that we have been to. We have also lectured at rotary clubs, at private sporting clubs and at general interest clubs.

Mr VAN MANEN: At the outset of your answer you mentioned lifestyle changes and diet. When you are speaking with those groups what is the message you are giving to them about issues to do with lifestyle and diet, to change what they are doing so they don't develop bowel cancer in the first place? Or is the message about ensuring that you get screening and checks?

Mr Frew : Firstly, I would very happily at another time present to you that presentation. I tend to refer to the aspect of the presentation that covers that area as the circle of life—it is a balance. I used to use a government program that is called 'two and five'—I understand it has now been superceded, but it is probably about to be replaced—which is all about two fruit and five veg. I generally head into it talking about what they've had for breakfast: we talked to a group yesterday, which was at Ausgrid—there were a dozen cablers. We talked about what they had for breakfast, we talked about what they had for lunch, we talked about what they do after work. Out of that I get them to tell me what their lifestyles are. On the screen in the PowerPoint presentation we have options that are available to them. Essentially, it is about fibre intake. I would not sit here and tell you that if you increased the fibre in your diet you would not get bowel cancer. There would be some people who might tell you that might be the case, but we would not support that. What we would support is a healthy lifestyle, moderation in alcohol, no smoking, and exercise. I think at the moment the recommendation is that 30 minutes five times a week is ideal, and it can be a power walk. The exercise can be as simple as that. Again, we try to integrate that into what is possible. We talk about walking with your next-door neighbour; we talk about walking with your family—those sorts of things. Anything above that is obviously a bonus. The other things that are alarming are comments to the effect that—let's just say that generic fast food is consumed in the home up to five times a week. It is not helped by the fact that some of the fast food outlets have promotions that are half price, so instead of, say, two pizzas it is four pizzas but it is the same amount of family consuming it. I have done some studies—and I'm more than happy, as I said, to pass on the information—that show that if I was to take you to a supermarket, for the amount of money that is spent on fast food I could provide you with a diet that would be substantially healthier than you would get out of fast food, and on the way through you would sit around the dining table again at home and probably have some really good conversation as well.

Mr Wiggins : I will just get back to the original question, which was: why do we have a high rate of bowel cancer in the first place? We do not actually know why Australia has one of the highest rates in the world. What we do know is that 70 per cent of all bowel cancer cases are influenced by diet and lifestyle—that is why the presentation is focused on that aspect—around 20-odd per cent are family history and then there are a small percentage where genetics are involved as well to make up the 100 per cent. Modifiable diet and lifestyle are the two important factors that contribute to around 70 per cent of all bowel cancer cases. As part of the presentations we do talk about screening, because clearly the earlier bowel cancer is detected the easier it is to treat and cure. Survival after five years, as Charlie said, is around 88 per cent if it is detected in the early stages.

CHAIR: Going back to my question and your response, Mr Frew, in which you identified exercise and diet as you see it: is that supported by other research?

Mr Frew : I would say that it is; I don't have it. I am more than happy to get that information for you. I'm currently doing some study in that area, so I would be more than happy to look into that for you.

CHAIR: What I am particularly interested in is their evidence that we are doing less exercise and our diet is getting worse, because that then leads into a response the government might want to take up about education. You were talking about the lack of awareness in your statement and the obvious risk factors in the development of bowel cancer.

Mr Frew : If I can just come at this from the back first and then come through, there is certainly a lack of awareness in relation to the program, which I mentioned in my opening statement. That in itself is an issue because, as taxpayers, we are all putting a substantial amount of money into this program as it is at the moment. It roughly runs—I think it has dropped nationally below a 40 per cent rate. Now if that was our brand—if you and I were in business together and that was our brand then we would be out of business, so that concerns me.

I can tell you that there is an extraordinary increase in non-communicable diseases in Western countries—in the US, New Zealand, Australia and United Kingdom. I can get you data that will support that, how that has grown, escalated over the past 10 or 15 years. You can see that also in life expectancies. Life expectancy in the seventies in Australia was 70, now it is up around 82 or 84, but people are dying from the non-communicable diseases, which are obviously your cancers and your cardiac issues and other stuff.

CHAIR: What do you think the government, or the department on behalf of the government, should be doing to advertise the programs so that people are aware? I have seen advertisements in the past in newspapers and on television, but I suppose there is a limit on how many times you can keep getting the message out.

Mr Frew : Most of that advertising is done on behalf of the charities or the organisation as a community announcement. So it is not what we would regard as mass media. I think that if you were to delve into the records of the department, the department would be able to show you a number that has been spent in the past on melanoma or skin cancers, for instance, as we move into a summer period, and you would find that that amount of money per year—let us just say it is $7 million—well, nothing like that has ever been spent on a bowel cancer awareness program. What I am saying, again as an individual and not necessarily as a representative of BCA, is that if we took bowel cancer as the lead in this particular issue and put a campaign around it, we would be helping other areas such as coronary heart disease and type 2 diabetes. It is a dreadful thing to say, but if you were to take type 2 diabetes, a lot of people would not understand what that is. They would ask: 'Is it a secondary? What does it mean?' Coronary heart disease: 'I'm fine. I walk up the stairs to work.' That does not cut it. It is a dreadful thing to say, but the two words combined have one word, which is cancer, and people understand what that is. So if we had a national health program that was centred on bowel cancer awareness, it is my personal opinion that that would assist in addressing areas of obesity and other areas that are affecting and contributing to these other diseases.

Mr Wiggins : The basis of everything we do is the NHMRC guidelines, and that is what we promote. Certainly the clinical management of bowel cancer is one of those. Physical activity and exercise is mentioned in there, fibre is mentioned in there, screening is mentioned in there so that is the rationale for the evidence-based approach that we promote. In terms of screening and raising awareness of the program, we undertook in 2007, with some department funding assistance, to raise awareness of their program. Unfortunately the caveats that came with it prevented us from using mass media and those types of forums to communicate the message. The department's issue was—we are almost playing a catch 22—the program was not available to everybody aged 50 and over every two years, therefore they did not want to actively promote it in a big way. It only targets those limited ages who are currently eligible for the program. So we are in this catch 22. Nobody necessarily knows they are at increased risk over the age of 50, but we are not prepared to invest in an awareness campaign nationally—say, for instance, like breast cancer did when mammograms came in for screening. It was a national campaign and the screening option was the call to action. So at the moment it is a catch 22 scenario.

Mr CHESTER: I am interested in the approach you took in your petition. You mention that 70 per cent of bowel cancer is lifestyle related but your petition is dealing with the screening program. Now that is not quite the situation of an ambulance at the bottom of the cliff rather than having a fence at the top. It is like a safety net half-way up. Why aren't you more focused with your petition on the lifestyle issues? Why is the petition focused on the screening program? I understand you think there are limitations as to the screening program, but if you are going to petition the government why you wouldn't you petition the government more along the lines of 'we need a national prevention program focusing on lifestyle issues'? I am interested in why you have gone down this path.

Mr Wiggins : The program was launched in 2006 after the pilot commenced in 2002. The real potential of the program falling over was predominantly the rationale for the petition in the first place. In terms of screening, the NHMRC guidelines state that if you screen and you screen frequently from the age of 50 at least once every two years you can reduce bowel cancer incidence by 20 per cent and mortality by up to 33 per cent. So that is why we have focused on that aspect of it, because it can actually make a serious impact in terms of the incidence and mortality within the country. In terms of preventative health, that just does not apply to bowel cancer. As much as 70 per cent is diet and lifestyle related. It covers a lot of chronic diseases. So that really, I would say, involves a whole of government approach across not only cancer but, as Charlie was saying, with type II diabetes and heart it would bring a lot of organisations in terms of the NGOs together which we could actually hook into with the system promoting that certainly the dietary guidelines and those sorts of things need to be promoted by all respective stakeholders, as it were, because we all at some point interact with good healthy messages regarding diet and lifestyle.

Mr Frew : There is another aspect to this, and it comes out in some of these group presentations. When somebody is diagnosed with cancer, and it does not matter what cancer it is but let us keep this on bowel cancer, there is obviously a lot of anger and to hear that there is a screening program around that does not apply to them or does not cover that particular age group is obviously followed by 'why not?' or 'what are you doing about it?' So the centre of our focus has been on that to increase that level of participation. I have this document which I can show you. As it sits at the moment it is over the top, and that is what we are proposing. From 50 on you start to get some awareness of the actual program, so it is over those two years, so you will get some consistency and some acceptance. There will always be people who will speak outside that. But in order to get the level up to where we want it is not an easy task. If you look at the breast screening program as it sits at the moment, I think you will find it is running at about 55-57 per cent.

Mr CHESTER: So if there is a 40 per cent return rate, which you depicted as being a poor result if you are in business—I think you said you would not be in business very long at that rate—what of the reluctance to participate? Has anyone done research on that reluctance? Is it a yuck factor involved? You are talking about a public awareness campaign. What do you attribute that 40 per cent return rate to?

Mr Frew : Speaking only as somebody who is doing these lectures, from which I do get a lot of this information, yes, there is the yuck factor and there is apathy. You would be amazed by the number of people who believe 'it is not going to happen to me'. For bowel cancer, the split roughly, male to female, is about 55:45. That is simply because the women have been prodded and poked from an early age and are a little bit more attuned to this sort of thing. If only you can get the woman to talk to her husband and say, 'Do this,' or the sister to talk to her brother, who has been showing symptoms for four years and doing nothing about it. Regretfully, when that person goes in and is investigated it is game on. I would say to you that in these lectures we would get an increased level of participation after that, but you have to wait for the date before you are offered it or take some alternative.

Mr Wiggins : Certainly I think bowel cancer, by its nature, has a yuck factor associated with it. People do not talk about it, to start with, so that is part of the problem. If they are not talking about it therefore they are not sharing their family history, which is also a risk factor for the disease especially if you are diagnosed under the age of 55 if you have a close relative because then your risk increases to three to six times that of the average person. Therefore, if people are not talking about it, not even with their family, then they are certainly not going to be talking about screening. The screening test itself involves faecal handling, and there is a barrier there participation-wise. We announced late last year an Australian development about a blood test for bowel cancer, which was certainly well received globally. That is still a little way off yet but there is movement along the line to make the test a little bit more palatable, as it were. Certainly the yuck factor is a big factor that needs to be overcome, as well as promoting the benefits of participating in screening; I do not think that has adequately been done yet.

Mr CHESTER: The previous minister in their response indicated there was $138 million over four years, I think in the 2011 budget, to continue the program. Have you done any work to indicate the preventable costs over that period of time if we had a more extensive program? You are saying 90 per cent are successfully treated and that screening is one of the most effective ways of reducing the impact. Have there been any costings done along those lines?

Mr Wiggins : Costings have been done. We have not done them, because other people have done them and they have done the research. I think there were some costings out of the Cancer Institute New South Wales, for instance. There have been some other costings and other research papers, which we can certainly provide, which answer the questions of having a $40 test kit, going on to have a colonoscopy and then going on to have bowel cancer, and the difference in the cost to the system. I think the argument was that it was a healthcare investment upfront in terms of screening because not everyone then has to go on to have chemotherapy or radiotherapy even if they have bowel cancer detected at an early stage. So there are some—

Mr CHESTER: But are our costings sophisticated enough to figure that out—that this is the cost of the program but these are the savings in five or 10 years time? Are we that sophisticated with our measurements?

Mr Wiggins : I believe we are. In terms of screening, Bowel Cancer Australia in 2010 launched the BowelScreen Australia Program to cater for about 4.8 million Australians who currently are not eligible for the government program, where they can go to a pharmacy and buy a test kit. We do not make any money on that; we merely brought the Pharmacy Guild into a partnership—the local Australian manufacturer actually exports more test kits overseas than they sell locally—and just to provide a call to action for everyone who was not eligible for the government program. So, first and foremost, if you are 50, 55, 60 or 65, we certainly recommend people do the kit when it arrives in the mail. But if you are 52, 54, 56 and so on, we recommend you go to the pharmacy where you have to purchase a kit, unfortunately.

CHAIR: What are the most important symptoms of bowel cancer which would give rise to a person going to visit their doctor to discuss it?

Mr Frew : Julien has mentioned the family history; that is extremely important. The symptoms would be chronic gut ache, diarrhoea. Essentially it is anything that is chronic that goes for a long period of time that your body is telling you is just not normal. The problem you face is that a lot of people think that if they have been overseas and had a meal that has been full of bacteria, they come back and do not write it off for one week but for six weeks, for three months, for six months. And it is just not the issue; it is something else.

Mr Wiggins : The most visible sign of bowel cancer is blood in the stool. That is when you have become symptomatic. Screening is not then recommended through the FOBT test kit because there is blood present. So therefore it is recommended that you go to the GP straightaway, and you would most likely have a colonoscopy to follow up the source of bleeding. It may not be bowel cancer, but certainly that is what is recommended in the guidelines. As Charlie mentioned, symptoms include abdominal pain occurring from four to six weeks and change in bowel habit. Once again, people know their own regular bowel habits and would notice a change in them for that period of time. In younger people it can be anaemia. It can be unexplained weight loss, which is not an obvious symptom but once again still needs to be investigated.

CHAIR: Is there any data on young people contracting bowel cancer?

Mr Wiggins : There has been some data on it. We certainly released some two years ago, but we keep it in context: of 14,000 people who are diagnosed every year, about 1,000 are under the age of 50. In terms of young people, we looked at 20- to 34-year-olds, and it is a very, very small population. It is increasing, but it is such a small base. I think the percentage increase at the time—I can confirm that—was about 57 per cent, but we are talking small numbers. A lot of the time they are young people, and our message to young people, especially if there is a family history—if they have a close relative diagnosed with the disease—is that they should never be told by their GP that they are too young to have bowel cancer, because the unexplained weight loss and anaemia, for instance, present to a GP and unfortunately their most immediate thought is not necessarily that it could be bowel cancer. So, if the young person is not convinced, we recommend that they have a second opinion, but they should never be told that they are too young to have bowel cancer.

Mr Frew : The mortality rates over the years are on the Department of Health and Ageing website, so you can grab them from there.

Dr JENSEN: I have two questions. The first question is about the ministerial response, and I do not know if this has been asked; I apologise for being late. Were you satisfied with the ministerial response to your petition? If not, why not? What were the issues?

Mr Frew : As the petitioner, I would have to say that we have been consistent in requesting a two-year screening program, as I think we have outlined in previous conversation. The petition was to increase the rate of screening. Yes, the screening program was reinstated, there was an extra age category added and there are going to be continuing age categories added, but it still does not fully answer or acknowledge what we are requesting, which is a two-year program from age 50 on.

Dr JENSEN: Also, I am not sure if you read the transcript of the hearings that we did on 20 March. One of the issues that I questioned them on was the average cost per test, and they were not able to provide me with that. Mr Wiggins, you were saying that you were comfortable that we had the data to make a comparison between the cost of doing a screening program and the cost of basically addressing problems later on down the track. I am talking just about the economic cost here, obviously, not the personal or social cost. Does it concern you that the department says that it cannot tell how much it costs to screen an individual?

Mr Wiggins : I think they can but, because of the commercial-in-confidence nature of their agreement with the kit supplier, I think they were reluctant to or not allowed to. In the private sector, the typical cost of a kit and pathology is about $39.35, so we can get a comparison. That is what it would be—

Dr JENSEN: Based on that.

Mr Wiggins : Based on that. That is certainly the recommended retail price. We could go back to the manufacturer, for instance, and ask for their marginal cost or the cost of actually producing the kit, which I suspect—by the time there is a mark-up in the system and everything else and everyone is involved—would come down from that. The pathology component of that price is $16.40 or something like that—and then the up-front cost is $22.95. So I think it would be safe to say you could easily work that out based on that model. We certainly know those sorts of figures, and that is through the program we run through the manufacturer.

Dr JENSEN: Have you run comparative costs yourselves as yet?

Mr Wiggins : Not comparative costs with the program, because once again we are not privy to any information.

Dr JENSEN: No, I am asking about comparative costs if you had a fully implemented two-year screening program, which is what you are suggesting, compared with the costs that we now incur as a result of people contracting bowel cancer and getting detected later on.

Mr Wiggins : As an organisation we have not actually commissioned that research, because it is already out there. So we use that research. We can certainly supply it to you. There are a number of different bodies, as I said before; you may not have been in the room then.

Dr JENSEN: No.

Mr Wiggins : The Cancer Institute of New South Wales some time ago published a report on that. There has been another report commissioned on the healthcare investment for bower cancer screening, which goes through the costs of the kits, colonoscopy and treatment compared to late-stage cancer. So those sorts of costs have been named. The program has been estimated, if it is fully implemented, to be about a $150 million investment, and that is for everybody over the age of 50 being screened every two years.

Dr JENSEN: Do you happen to recall what the comparative cost was for—

Mr Wiggins : As I recall it, the average cost was about $50,000 to $60,000 to treat per bowel cancer case for advanced cancers.

Dr JENSEN: Okay, and how many do we have annually or every two years—

Mr Wiggins : We have 14,000 people diagnosed every year, of whom 4,000 die from the disease, so the economic cost of bowel cancer can certainly be worked out.

Dr JENSEN: Thank you very much.

Mr Wiggins : On that point with the minister's response, the former minister also flagged access to colonoscopy, which seems to be coming up as a recurrent issue. We do not see that that necessarily is an issue. There are, I think the department said, about 600,000 colonoscopies done annually in this country. A fully implemented program will actually add around one quarter of that number in additional colonscopies. But what they failed to say was that it is actually going to be 21 more years before their program is fully implemented. So we are talking 2034, yet this has been known well and truly since the pilot and the evaluation. Since 2002, this was flagged as an issue that access to colonoscopy was always going to be a potential bottleneck for the program. Certainly with the public-private split in providing colonoscopy services, if done right, there really should be no bottleneck. There is a lot in the system that could well be unnecessary colonoscopies, which could be freed up to allow the positive FOBTs through a program to flow through without adding a burden to the system.

Dr JENSEN: You were talking about the fact that you may not need a colonoscopy or chemotherapy if it is detected early.

Mr Wiggins : You will always need a colonoscopy. If it is a positive test, it will go to colonoscopy because the colonoscopy will determine if you have cancer or a polyp, or not at all. From there, if it is early stage, you may not need chemotherapy, depending on the stage of the cancer.

Dr JENSEN: You just have it cut out.

Mr Wiggins : You have it cut out, that is right—you still have surgery.

Dr JENSEN: Okay.

Mr CHESTER: Who does it better than Australia? Sorry to focus on return rates again, but return rates are only 40 per cent. Who has looked at the messaging as to how you might get a higher rate or is sending out bowel cancer screening kits not a good way to get a high return rate? Is it just not going to get above 40 per cent? Are there examples around the world where similar programs get better return rates than that?

Mr Wiggins : There are. Just looking at BowelScreen Australia, for instance—and we acknowledge that people actually have to purchase the kit—the return rate is 70 per cent. We do not know why, but we infer that because someone has actively made an outlay, they do it. When kits arrive in the mail, it could be for a number of reasons that people do not participate. They may have already have had a colonoscopy, therefore it is not relevant to them. Their GP may have said, 'No, at this stage, we will have you on another path.' There are other factors, or they have had their FOBT via their GP, which would be outside the system.

Looking at the UK, that would probably be the model that we would look to, and we did when we released the bowel cancer challenge last month. In the UK, for instance, they were still aiming to screen everybody from 60 to 74. They started the same time as our National Bowel Screening Program. In the same time period, they were screening everybody from 60 to 70 every two years. So it can be done. The participation rate is higher when people turn 60 and onwards. Our program has shown that there is a higher participation rate in that older category. Risk increases with age.

What we have called for is to look at the UK model. We understand that there are budgetary parameters and everything else. We are realistic about that. We are trying to provide practical solutions. Rather than trying to do the 50- to 74-year old in one block, which results in this five-yearly screening and is inconsistent with two-yearly screening in the NHMRC guidelines, we should take a 10-year block, for instance, and screen everybody every two years. At least we are helping in terms of conditioning people to receiving a kit quite frequently. It helps with the consumer message. Therefore, it is consistent with NHMRC guidelines. It helps NGOs, health professionals and everybody else in the area with the one consistent message—that is, screen at least once every two years.

Mr CHESTER: In terms of private sector partners to try to increase this return rate, why couldn't you look at the health insurance sector, for example, and provide a $20 rebate to people who return their kits? They have a vested interest in this as well.

Mr Frew : They do at the moment.

Mr Wiggins : They do.

Mr CHESTER: If that is not enough incentive, you are still are on only 40 per cent.

Mr Wiggins : The 40 per cent is the national screening program, which is outside private health insurance. It is a free kit from the government that arrives in the mail based on your Medicare card and your age.

Mr CHESTER: The insurance industry more generally, particularly life insurance, obviously have a vested interest too, have they not?

Mr Wiggins : I have no arguments there. Certainly in terms of BowelScreen Australia, yes, private health insurance does provide a rebate for the test kit and the pathology—some of them for the entire cost of the kit. So they have seen the value in rebating that as a health measure.

Mr Frew : Some of the health companies—Medibank Private, for instance—have held health seminars, and we have spoken at them about us and other issues of health and medicine. So it does happen.

Mr VAN MANEN: You mentioned the UK model, where they have gone for two-yearly bowel screen for people over the age of 60, and that is an avenue you are asking us to consider or to go down. What has been the benefit of changing to that two-yearly bowel screening in the UK in terms of reducing the incidence of people finishing up with full blown bowel cancer as a result of early detection et cetera? Has there been a significant fall in cases?

Mr Wiggins : The UK did it in two stages. They had an accompanying awareness campaign as well. The awareness campaign covered off symptoms and screening, so people with symptoms were going to their GP in the first instance, which is what they wanted them to do. I can get you the screening data from the UK. There has been some research done on participation and the number of lives saved by the screening program. There is data out there cited, but I do not have it on me at this point in time.

Dr JENSEN: Mr Frew, what prompted you to draw up this petition in the first place?

Mr Frew : As I said in my opening remarks, we were approached by a supporter of Bowel Cancer Australia. Her mother had been diagnosed with late-stage bowel cancer. It was in the liver. She was an athlete and I did a bit of cycling, so we decided to put this together and ride it down to Canberra. Personal involvement was spurred on by the fact that I have known a number of people who have had bowel cancer. I do a number of lectures where I see this firsthand. You can be assured that, if you have a room of 20, 30 or 100 people, there is a percentage of people there who have been touched in some way by bowel cancer.

Dr JENSEN: Assuming bowel cancer is preventable and with competing budget priorities, could resources be better targeted at preventative programs rather than comprehensive biennial screening programs for certain demographics?

Mr Frew : I think there is always an answer to everything. It is always a question of how much money you have. We have talked today about so many other aspects. We have not touched on, for instance, downtime in the workforce because of this disease. How do you factor that in? You can look at it as broadly as you wish, and there are economies of scale. You could implement a program where everyone gets a free colonoscopy at 50, and that would lower the prevalence of this disease dramatically, but what is the cost of that compared to what we are doing? I do not have the numbers. I could not give you a comparison.

Mr Wiggins : To go back to the NHMRC guidelines: if we are serious about making a dent in bowel cancer in this country, screening from the age of 50 at least every two years is what is recommended. It is evidence based. It is well and truly researched. Many screening programs throughout the world show the benefits of participating in screening and reducing mortality. The issue we have is the ageing population; from age 50, your bowel cancer risk doubles. Unfortunately, we are all coming up to that mark or over it. Risk progressively increases with age, and we just cannot get away from that fact. If we can get the population conditioned to regularly screen themselves every two years from the age of 50, I think that and encouraging more people to participate in screening in the privacy of home are the best uses of resources we could possibly do

CHAIR: To follow on from that response: are you able to discuss a preferred approach to testing for bowel cancer in the under-50 age group?

Mr Wiggins : Under 50 is difficult because it is not recommended in guidelines on a population screening basis. Certainly the number of people under the age of 50 diagnosed is 1,000 compared to 13,000 over the age of 50, so risk increases with age. Younger people can avail themselves of test kits through pharmacy at this point in time if they choose to. I think that, for a lot of people in the younger age brackets—I assume we are talking as young as 20- to 40-year-olds, for instance—it is not recommended for them at a population screening level. We are talking about, in 2008, 133 cases of bowel cancer diagnosed in people aged 20 to 34. So it is not a huge population by any stretch of the imagination. Family history is the important message for them, especially, as I said before, if their parent was diagnosed under the age of 55, because their risk increases by three to six times. But for them—and a number of our ambassadors have had parents who have been diagnosed under the age of 55—the trajectory is different to a FOB test. They would normally be screened via colonoscopy when they are 10 years younger than when their parent was first diagnosed, so it is a different pathway for them. Likewise, if they are presenting with symptoms, the message is: just talk to your GP and have it investigated. That is all we can do.

Mr VAN MANEN: Just to follow on from the chair's question, how proactive are our GPs in talking to their patients about this when they turn 50 or if they are older? Because, obviously, that is a key component to making this work.

Mr Wiggins : I cannot speak for GPs. I think—

Mr VAN MANEN: Obviously, you get the feedback from the GPs when you talk to them, so how proactive are they in—

Mr Frew : Our recommendation to people, through our awareness programs, for instance, is: take this matter to your GP, discuss it with your GP. So, if people have a known family history of bowel cancer, we recommend strongly that they discuss it with their GP. If they have other gut issues—again, we say that increases the risk of bowel cancer—they should raise that with their GP. But we cannot really speak for GPs.

Mr VAN MANEN: But you are also speaking to the GPs to get them to think about this as a top-of-mind issue.

Mr Wiggins : GPs and pharmacists are key to the success of any screening program. They are health professionals; patients value what they say. We have worked with some pilot programs out of Victoria which actually demonstrated that, once a GP promotes the program to the target population, more people participate. So we have been working on the pilot schemes there—but, certainly, far more work needs to be done and can be done.

CHAIR: Mr Frew and Mr Wiggins, I want to thank you for your appearance before the committee today and for the information you have provided. The committee have a couple of other questions with some component parts that we would like you to take on notice and provide a written response to, which would be for the information of the committee only—because of course the enemy is time, and it has beaten us as it always does in these public hearings. This has been an incredibly instructive and informative discussion for the committee. Against the background that we want as much information as possible for the purposes of the department's and the government's further considerations, we will provide those questions to you for a written response. I would just ask by way of a final question just what your expectations were of your petition and your appearance here today; and do you believe those expectations have been met?

Mr Frew : My expectation of the petition was to achieve what we have achieved, which was to raise awareness to get some response. The response, frankly, was not exactly what I had hoped for—on the lower end, a couple of extra years of screening at five-year gaps; at the top end, two years, which is what we have spent a fair bit of time discussing today. Any opportunity to appear before any committee that looks into something like this is a step forward. So we would simply say: thank you very much for your time.

CHAIR: Thank you very much. A copy of the Hansard transcript will be sent to you to see that you have been faithfully recorded here today. Obviously, you cannot change your answers. We just want to make sure that what you have said has been properly recorded—

Mr Frew : Right—or you'll call us up again!

CHAIR: We look forward to the responses to the questions on notice we will give you through the secretariat for the further consideration by the committee.

Mr Frew : Thank you very much.

Proceedings suspended from 10:48 to 11:00