This year the home-based bowel cancer screening test – a national program – became available upon request to people aged 45 to 49.

That represents 1.6 million Australians. It was previously available only to those over 50.

According to newsGP – the news arm of the RACGP – doctors “are being urged to talk to their patients about accessing the tests and to order kits for their practices”.

There have been a few ads on the TV, but overall it has been a quiet rollout – if an important one.

This is the same test that’s mailed out to people aged 50 and over every two years (up until the age of 74).

Check the mail

You’ll get it in your mailbox whether you want it or not.

And many people don’t want it.

We know this because of the high numbers of people who choose not to take the test.

Meanwhile, the number of people under the age of 50 developing colorectal cancer has been on the rise for more than 20 years. Poor diet and alcohol are suspected to be drivers.

Making the test more accessible is partly in response to younger people with bowel cancer (although the sharpest rise appears to be in people aged 20 to 29).

Lowering the access age to 45 is an attempt to slow plummeting test rates – and to increase early diagnoses. Will it help?

Bowel cancer is the nation’s second deadliest cancer. Early detection proves 99 per cent successful for treatment. And yet testing rates continue to fall.

Why the low take-up?

Many Australians have an aversion to the test because of an ‘ick’ factor. The test involves collecting two tiny samples of stool, and putting it in the post.

Since the National Bowel Cancer Screening Program began in August 2006, screening participation rates have not surpassed 44 per cent.

Men, in particular, have routinely dragged the chain.

The program was slowly gaining ground, until Covid hit. That led to a decline in participation for the first time in 10 years.

According to the Australian Institute of Health and Welfare, the national participation rate in the program had increased from 38.9 per cent of invited people aged 50 to 74 in 2014-2015 to 43.8 per cent in 2019-2020.

Then, suddenly, the participation rate dropped to 40.9 per cent in 2020-2021.

Men (38.9 per cent) had a lower participation rate than women (42.8 per cent).

Latest figures aren’t encouraging

A recent report by the Australian Institute of Health and Welfare shows particularly low screening participation rates in men aged 20 to 54.

Some 71 per cent of them are not participating in the program.

That is, 29 per cent of men in their early 50s took a screening test in 2021-2022.

Approximately 860,000 Aussie males in this age group were invited to screen. And they would have received a test in the mail.

More than 600,000 of them ignored the invitation.

Women aged 50 to 54 didn’t do much better, with only 33 per cent taking part.

Pathology Awareness Australia ambassador Dr Nick Musgrave is an anatomical pathologist who specialises in gastrointestinal pathology.

“When younger populations delay their bowel cancer screening test, they are at risk of missing pre-malignant lesions that occur in the colon,” Musgrave said.

As a result of this, he said, these lesions inevitably progress to become more advanced lesions and invasive bowel cancer.

If bowel cancer is caught at an early stage, “the patient can have much better outcomes and be cured”.

By putting off the test until an older age “when people perceive they are at higher risk, we miss the opportunity to intervene and provide a cure, which is really tragic”.

Key findings of the AIHW report

• Overall participation for the two-year period 2021-2022 has dropped to 40 per cent. It was 43.8 per cent in 2019-2020
• Participation rate was poor overall – 31 per cent –  in the younger age group 50 to 54 years
• Participation increased with age, and 50 per cent of Australians in the 70 to 74 age group undertook testing
• 72 per cent of those who previously participated in the screening program, participated again in 2021-2022
• One in 25 people assessed after a positive bowel cancer screening test was diagnosed with a confirmed or suspected cancer in 2022.