Bowel Cancer Screening in Australia: Research and Tactics to Achieve an Advocacy Goal

Background and context: Bowel cancer is the second leading cause of cancer death in Australia, yet survival is above 90% if it is detected at stage one. Cancer Council Australia has advocated since 1997 (when RCT evidence was published) for a national government-run screening program—a challenge to any government, given the costs and changes across the health system, irrespective of the health benefits. Cancer Council Australia has advocated at every step in the program’s development, from pilot studies to securing bipartisan political support for the program´s introduction to funding allocations linked to our budget submissions. Yet cost pressures restricted the Australian Government in 2013 to implementation by 2034 - an unacceptable timeframe in view of preventable deaths over that period. To find a peer-reviewed “big number” to convince candidates in Australia´s 2013 federal election to support full implementation by 2020, Cancer Council commissioned a study of multiple screening scenarios submitted to a leading medical journal, showing our implementation plan would prevent 35,000 bowel cancer deaths by 2040. The incoming government, despite campaigning on national debt-reduction, allocated almost $100 million dollars—the centrepiece of its first health budget—to Cancer Council Australia´s plan, attributing the decision to our advice. Subsequent Cancer Council Australia research has shown the program´s life-saving benefits to be even greater if participation can be increased, and that it would achieve net savings. We continue to push for program promotion, with our peer-reviewed research showing 60% participation would prevent 84,000 bowel cancer deaths by 2040. Aim: To highlight how political advocacy and scientific research can work together by ensuring the advocacy is based on the best available evidence, with that evidence collected through a peer-reviewed study designed to deliver major policy reform. Strategy/Tactics: The key strategy/tactics were basic but often overlooked: collect the most compelling evidence of benefit, thereby making it difficult for politicians to dismiss the advocacy. The example of bowel cancer screening advocacy in Australia since 2012-13 has been presented in Australian research institutes to highlight how studies can be designed expressly to translate to a major policy outcome. Program/Policy process: Cancer Council Australia adhered to all government processes within its advocacy remit (budget submissions, being appointed to government committees, producing clinical practice guidelines) while working independently to drive the research and public policy agenda. Outcomes: The accelerated implementation of a landmark national screening program. What was learned: That even politicians obsessed with budget cuts can´t always argue with the best evidence—and that researchers can design studies that change policy and practice, if guided by political pragmatists.