TL;DR — Bowel cancer is one of Australia’s most common cancers and one of the most preventable. The National Bowel Cancer Screening Program (NBCSP) sends a free, at-home FIT test (sometimes called FOBT) to Australians aged 50–74 every two years; from 1 July 2024, anyone aged 45–49 can request a free kit. A positive test is followed up with a colonoscopy — the procedure that actually finds and removes precancerous polyps before they turn into cancer. Dr Goutham Sivasuthan offers no-gap screening and follow-up colonoscopy in Brisbane, Redland and Logan.

Quick links: Am I eligible for the NBCSP?  |  FOBT vs colonoscopy  |  What happens after a positive FIT  |  Family history pathway  |  Book a screening colonoscopy

Why bowel cancer screening matters

Bowel cancer (colorectal cancer) is the second most common cause of cancer death in Australia. About 15,000 Australians are diagnosed each year, and around 5,000 die from it. The reason it’s emphasised in national screening programs is that — almost uniquely among cancers — it is highly preventable. Most bowel cancers start as a small, slow-growing adenomatous polyp; removing the polyp at colonoscopy prevents the cancer that would otherwise develop years later.

If bowel cancer is diagnosed at Stage I (still confined to the bowel wall), 5-year survival is approximately 99%. If it’s diagnosed at Stage IV, 5-year survival is about 13%. The whole point of screening is to catch it at Stage I — or, even better, to prevent it altogether by removing the polyps before they become cancer.

Australian incidence and survival figures cited above are drawn from Cancer Council Australia, AIHW Cancer Data in Australia, and Bowel Cancer Australia. Specific year-on-year figures

Who is eligible for the National Bowel Cancer Screening Program?

Age	NBCSP eligibility	What you receive
Under 45	Not eligible through NBCSP	If you have symptoms or a strong family history, see your GP — screening or diagnostic colonoscopy may still be appropriate
45 – 49	Eligible to request a free kit (since 1 July 2024)	Order online at health.gov.au or phone the program on 1800 627 701
50 – 74	Eligible — kit sent automatically every 2 years	Free FIT (FOBT) kit mailed to your registered address
75+	No longer in the routine program	Discuss with your GP — screening may still be appropriate based on your health and life expectancy

If your kit has been sent but lost or thrown out, you can request a replacement through the same channels. If your address has changed, update it with Medicare so the kit reaches you.

FOBT vs colonoscopy — what’s the difference?

These two tests do different jobs. They are not interchangeable.

	FIT / FOBT (faecal immunochemical test)	Colonoscopy
What it does	Detects microscopic blood in a stool sample	Direct visual examination of the entire large bowel; removes polyps in the same procedure
Where it’s done	At home	Private day-surgery facility or hospital, under sedation
Frequency	Every 2 years (NBCSP)	Once every 5–10 years if normal; sooner if polyps were found (see surveillance intervals)
Cost	Free through NBCSP	No-gap with eligible private health insurance; transparent self-funded packages (cost page)
Detects polyps?	No — only blood	Yes — and removes them at the same time
Detects cancer?	Indirectly (some cancers bleed; some don’t)	Directly — visualises and biopsies
Preparation	None — just collect a sample	Low-residue diet + bowel prep the day before (see prep guide)
Sensitivity for cancer	~70–80% (single test)	> 95% when performed to GESA quality standards (see quality metrics)

The screening pathway in Australia is two-stage by design. A FIT kit is a cheap, easy, scalable way to identify the small percentage of people in the population most likely to have polyps or cancer. Those people then have a colonoscopy — the test that actually finds and removes the polyps.

What happens if your FIT is positive?

A positive FIT does not mean you have cancer. About 1 in 13 NBCSP screens come back positive; of those, the majority are caused by polyps, haemorrhoids, or other benign sources of bleeding. But a positive result does mean a colonoscopy is the next step — it’s the only way to know what is causing the blood.

National guidelines (NHMRC, Cancer Council Australia) recommend a colonoscopy within 120 days of a positive FIT result. Earlier is better. Dr Goutham accepts direct GP referrals for positive-FIT follow-up — typical wait time is 2–4 weeks.

• Step 1. Take your positive FIT result to your GP
• Step 2. GP writes a referral for colonoscopy (covered by Medicare/private health insurance for positive-FIT follow-up)
• Step 3. Practice contacts you to book the procedure date and prep instructions are sent
• Step 4. Colonoscopy is performed — any polyps are removed at the same time and sent for pathology
• Step 5. Results discussed on the day; pathology report and surveillance recommendation follow in 7–14 days

Symptoms that mean you should not wait for a screening kit

Screening is for people without symptoms. If you have any of the following, see your GP for a referral to colonoscopy — do not wait for the next NBCSP cycle, even if your last FIT was negative:

• Visible blood in your stool (bright red or dark)
• A persistent change in bowel habit lasting more than 2–3 weeks (new constipation, new diarrhoea, change in stool calibre)
• Unexplained weight loss
• New, unexplained iron-deficiency anaemia (especially in men, and in women after menopause)
• Persistent lower abdominal pain or a palpable lump
• Tenesmus — the feeling of incomplete emptying after a bowel motion

These are red flags, not diagnoses. Most people with these symptoms do not have cancer — but the only way to be sure is to investigate.

Family history changes the rules

If a close relative (parent, sibling or child) has had bowel cancer or advanced polyps, your personal risk is higher than the general-population average, and your screening should start earlier and run more often than the NBCSP cycle. The general principle is:

Family history	Recommended screening
One first-degree relative diagnosed ≥ 55 years	FIT every 2 years from age 45; consider colonoscopy from age 50, then every 5 years
One first-degree relative diagnosed < 55, OR two first-degree relatives at any age	Colonoscopy every 5 years from age 40 (or 10 years younger than the youngest affected relative, whichever is earlier)
Three or more affected relatives, or a relative diagnosed under 50, or known Lynch syndrome / FAP	Genetic counselling and a tailored surveillance program — usually colonoscopy every 1–2 years starting in the 20s

This is a general summary based on NHMRC and Cancer Council Australia guidance. Personal risk is influenced by the number, age, and tumour type of affected relatives — discuss with your GP or with Dr Goutham at consultation. The full surveillance schedule once a colonoscopy has been performed is detailed on the surveillance intervals page.

How a screening colonoscopy works

A screening colonoscopy takes about 20–40 minutes (start to finish you’ll usually be at the day surgery for 3–4 hours including recovery). You’re sedated, so the procedure itself is not felt. Dr Goutham uses a high-definition colonoscope with advanced imaging to inspect the whole large bowel from rectum to caecum. Any polyps found are usually removed in the same procedure (polypectomy) and sent for pathology.

The single most important determinant of whether polyps are found is the quality of the bowel preparation — a clean bowel allows a high-quality examination. See the bowel preparation guide for the day-by-day countdown.

After your screening — what to expect

• Normal colonoscopy, no polyps. Next colonoscopy in 10 years (or back to FIT every 2 years through the NBCSP).
• 1–2 small low-risk polyps removed. Repeat colonoscopy in 5 years.
• Multiple polyps, or any advanced polyp (large, villous, or high-grade dysplasia). Repeat in 3 years.
• Numerous polyps or incomplete removal. Repeat in 1 year.

The full risk-stratified schedule is on the surveillance intervals page.

Cost of screening colonoscopy in Brisbane

For patients with eligible private health insurance, Dr Goutham’s screening and surveillance colonoscopies are no-gap at contracted private day-surgery facilities — meaning no out-of-pocket cost for the surgeon’s fee. Self-funded patients pay a published fixed-price package. NBCSP positive-FIT follow-up colonoscopies are also covered. See the cost page for Medicare item numbers and current package prices.

Frequently asked questions

I’m 47 and feel fine. Should I bother with the NBCSP kit?

Yes — if you can. From 1 July 2024 the NBCSP was expanded so that anyone aged 45–49 can request a free FIT kit. The reason for the expansion is that bowel cancer rates in Australians under 50 are rising. The kit is free and takes ten minutes at home; there is essentially no downside.

My FIT was negative two years ago. Do I still need to do it again?

Yes. A single FIT detects about 70–80% of cancers and a smaller share of advanced polyps. The reason it’s done every 2 years is that repeated testing brings the cumulative detection rate up to around 95%. Skipping cycles is the biggest reason people miss cancers picked up by the program.

My FIT was positive. How worried should I be?

Most positive FITs are not due to cancer. The most common findings at the follow-up colonoscopy are polyps (which are removed there and then) or haemorrhoids. About 1 in 30–40 positive FITs leads to a cancer diagnosis — and those cancers caught at screening have far better outcomes than those diagnosed when symptoms appear. The right next step is to see your GP and book the colonoscopy.

Can I just have a colonoscopy instead of doing the FIT?

Yes — if you have private health insurance or can self-fund, you can choose to go straight to a screening colonoscopy. It’s more sensitive than FIT but more invasive and requires sedation and preparation. Many people prefer the 10-yearly colonoscopy pathway because they don’t have to think about it again for a decade. Others prefer the easier 2-yearly FIT and only have a colonoscopy if needed. Both pathways are legitimate; the right choice depends on personal preference, family history, and access.

My parent had bowel cancer. When should I start screening?

See the family-history table above. As a general rule: if one parent or sibling was diagnosed at ≥ 55, start FIT from 45 and consider colonoscopy from 50. If they were diagnosed younger, or you have two affected first-degree relatives, colonoscopy is recommended from age 40 (or 10 years younger than the earliest affected family member). Strong family histories and known syndromes (Lynch, FAP) need a tailored plan with genetic counselling.

What are the symptoms of bowel cancer?

Visible rectal bleeding, persistent change in bowel habit (new constipation, new diarrhoea, change in stool calibre), unexplained weight loss, new iron-deficiency anaemia, persistent lower-abdominal pain, or a feeling of incomplete emptying. Early bowel cancer often has no symptoms — that’s the whole reason for screening. By the time symptoms appear, the cancer is more likely to be advanced.

Is bowel cancer screening covered by Medicare?

The FIT kit through the NBCSP is free. A follow-up colonoscopy after a positive FIT attracts a Medicare rebate (under item numbers 32222 / 32223 / 32229). Most insured patients have no out-of-pocket cost at Dr Goutham’s no-gap contracted facilities. See the cost page for the full fee structure and item numbers.

How long does the whole pathway take?

From posting the FIT to receiving the result: about 2 weeks. From a positive result to colonoscopy: typically 2–4 weeks for elective bookings (sooner for urgent cases). Pathology results from any polyps removed: 7–14 days after the procedure.

Book a screening colonoscopy in Brisbane

Dr Goutham Sivasuthan — FRACS, GESA-accredited — offers no-gap screening and surveillance colonoscopy at private day-surgery facilities across Brisbane, Redland and Logan. Phone 07 3733 1551, email the practice, or send a GP referral via the contact form.

See also: About Dr Goutham  |  Bowel preparation guide  |  Cost & no-gap options  |  Surveillance intervals