Gaps in Colorectal Cancer Care: Symptom Investigation, Screening, and Colonoscopy Access in Australia

Recent reports reveal significant inconsistencies in how colorectal cancer is detected and managed across Australia, from initial symptom checks in general practice to participation in the national screening program and access to follow-up colonoscopy.

A synthesis of recent reports reveals inconsistencies in how colorectal cancer is detected and managed in Australia, spanning initial symptom investigation, screening program participation, and access to follow-up diagnostic procedures like colonoscopy.

Symptom Investigation in General Practice

A study published in the British Journal of General Practice analyzed data from 70,107 patients aged 40 and over who presented with colorectal cancer-related symptoms between 2008 and 2022. The findings highlight substantial variation in how symptoms were investigated.

Key findings from the study include:

• Abdominal pain (32%) and diarrhoea (21%) were the most common symptoms reported.
• No investigation or treatment was recorded in 50% of cases for constipation and diarrhoea, and in 20% of cases for a change in bowel habits.
• Colonoscopy or specialist referral occurred most frequently for rectal bleeding (67%) and a change in bowel habit (60%).
• Of the total patients, 378 (0.5%) were diagnosed with colorectal cancer within 12 months. Anaemia had the highest positive predictive value for a cancer diagnosis, followed by rectal bleeding.

Associate Professor Joel Rhee from the Royal Australian College of General Practitioners (RACGP) noted that the study does not account for the full clinical context, such as symptom duration or prior investigations. He stated that red flag symptoms were appropriately investigated but described the socioeconomic and rural gradients in investigation rates as concerning.

"Red flag symptoms were appropriately investigated but the socioeconomic and rural gradients in investigation rates are concerning."
— Associate Professor Joel Rhee, RACGP

National Bowel Cancer Screening Program Uptake

Data from the National Bowel Cancer Screening Program (NBCSP) shows that mortality rates for bowel cancer in the 50–74 age group have declined from 44 per 100,000 in 2006 to 23 per 100,000 in 2025. The program has detected 17,378 bowel cancers since its introduction in 2006.

Screening participation data indicates:

• Between January 2023 and December 2024, 6.4 million eligible people were invited, with a 42% participation rate.
• Of those screened, 83.5% participated again when reinvited.
• The rate of positive screening results was 5.8% (1 in 29 people) in the same period.
• In July 2024, the eligibility age was lowered to 45. Of 236,421 test kits requested by those aged 45–49, 56.2% were completed, with 4.7% returning a positive result.
• Early onset bowel cancer (in people under 50) is increasing, with one in nine new cases now occurring in this age group.

Associate Professor Rhee described the decline in mortality as encouraging, citing likely drivers including screening, awareness, and improved diagnosis and treatment. He identified increasing overall screening participation as a more immediate issue than lowering the eligibility age further.

"The decline in mortality is encouraging, but increasing overall screening participation is the more immediate priority."
— Associate Professor Joel Rhee, RACGP

Disparities in Colonoscopy Access

The latest Atlas of Healthcare Variation report indicates significant and growing disparities in access to Medicare Benefits Schedule (MBS)-subsidised colonoscopy services. The report identifies a pattern of higher colonoscopy rates in major cities and affluent areas, while bowel cancer mortality rates are higher in remote and socioeconomically disadvantaged regions.

Specific findings on colonoscopy access include:

• Rates of colonoscopy are higher in major cities compared to other areas.
• The most disadvantaged areas have the lowest colonoscopy rates.
• Between 2013–14 and 2023–24, the national rate for repeat colonoscopies before the recommended three-year interval decreased by 8%. This decrease was 6% in major cities but 26% in remote areas. The rate decreased by 17% in the most disadvantaged areas but increased by 2% in the least disadvantaged areas.

The report suggests the observed patterns may be related to factors including clinician availability, out-of-pocket costs, public awareness, logistical barriers, and funding models.

Efforts to Address Variation and Improve Quality

Several initiatives are underway to address disparities and ensure appropriate care:

• Workforce development: The Gastroenterological Society of Australia's (GESA) Regional, Remote, and Indigenous (RRI) program is working to develop the workforce and reduce disparities in remote communities.
• Clinical standards: The revised Colonoscopy Clinical Care Standard, released in September 2025, mandates processes for referral, procedure execution, and follow-up. It guides clinicians to review previous colonoscopy reports and confirm alignment with surveillance guidelines before scheduling repeat procedures. The standard also emphasizes clear communication of findings to patients and general practitioners, including uploading reports to shared health records like My Health Record.
• Data-driven improvement: Healthcare services and clinicians are encouraged to use the interactive data in the Atlas report to assess local colonoscopy rates and address identified gaps.

The study authors from the British Journal of General Practice suggested developing structured diagnostic pathways and improving decision support tools to balance cancer detection with avoiding over-investigation.