Rural and disadvantaged patients get fewer colonoscopies, according to new research from the Australian Commission on Safety and Quality in Health Care.
Improved communication between patients, colonoscopists and GPs is one of the key features of the latest Colonoscopy Clinical Care Standard, as new data paints a picture of growing access inequality across the country.
According to an Australian Commission on Safety and Quality in Health Care (ACSQHC) report presented at the World Congress of Gastroenterology and Australian Gastroenterology Week 2025 in Melbourne on 21 September, the past decade has seen an 8% decrease in the number of people receiving MBS-subsidised repeat colonoscopies within three years of their original colonoscopy.
This overall decrease was far more pronounced in areas of socio-economic disadvantage and in rural areas.
Australians living in major cities went from receiving around 543 early repeat colonoscopies per 100,000 people in 2013 to receiving 510 early repeat colonoscopies per 100,000 people in 2023, representing a 6% decrease.
For rural Australians, the rate went from 157 early repeat colonoscopies per 100,000 people in 2013 to 116 early repeat colonoscopies per 100,000 people in 2023, representing a 26% decrease.
Where the proportion of people in Australia’s least disadvantaged regions who received an early repeat colonoscopy increased by 2% over the decade, the proportion of people in Australia’s most disadvantaged regions who received an early repeat colonoscopy decreased by 17%.
While there is no hard number on exactly how many people should be having a repeat colonoscopy within three years, GP and ACSQHC medical advisor Dr Phoebe Holdenson Kimura said the levels of variation between groups was cause for concern.
“There’s so much variation that it does make us wonder whether some people, particularly in affluent areas, might be receiving repeat colonoscopy too early, unnecessarily,” she told Oncology Republic.
“And equally, [are there] people in those geographically more remote or rural areas, or people in less affluent areas that perhaps do need that repeat colonoscopy, but for whatever reason, they’re not having it? “I think, potentially, we’re seeing both of those things happen.”
Gastroenterologist Professor Ben Devereaux, immediate past president of GESA and the current strategic lead of GESA’s regional, remote and Indigenous committee, told GR that work was already underway to help close the colonoscopy gap in the regions.
“We have a five-year relationship with the Northern Territory government … and we have three pillars within that,” he said.
“We have established training programs for gastroenterology trainees in Darwin and in Alice Springs, we support those fellows with a visiting professor program where four professors from the leading centres around the country visit those centres to build clinical and research links.
“And then we’ve also established the Gut Centre program in Alice Springs, which is a conference held every year.
“We’ve just had our third one … over three days, we take Australia’s leaders in gastroenterology, liver disease and leaders in gastrointestinal nursing to Alice Springs.
“We undertake training, endoscopy lists and upskilling, we provide lectures and updates at all of the hospital meetings that week and we undertake a multidisciplinary seminar each night, incorporating international, national and local experts; and that’s available and live streamed in real time.
“We have people dialling in from all over the country and indeed internationally, because for that week, Alice Springs is the epicentre of gastrointestinal education.”
With the initiative now in its third year, Professor Devereaux said he hoped it would build professional, clinical and academic links that would create an improved work environment for Australia’s rural and regional gastroenterology clinics, leading to better staff recruitment and retention.
“And by doing that, we can provide better services, including colonoscopy for people in regional and remote areas,” he said.
On the part of GPs, Dr Holdenson Kimura encouraged primary care clinicians to use the interactive data map published by the ACSQHC to get a clearer picture of whether people in their immediate area were receiving early repeat colonoscopies.
“You can actually interrogate the data and see how the data compares between where you work or … [look] at the population which you serve, and go, ‘this rate is very similar to the rates around us’, or perhaps it’s quite different,” she said.
“And [you can think about] what are the potential causes for that, but also what are the ways that the service can adapt to try and meet the needs of its population?
“Understanding the problem and articulating the problem is the first step … particularly since we’re seeing that disparity, unfortunately, appears to be widening over the last 10 years.”
While she acknowledged that no one GP could solve the issue of access and affordability, Dr Holdenson Kimura said there was a role for GPs to play in advocating for patients they were concerned about.
“In Australia, only four in 10 eligible people are actually participating in bowel cancer screening,” the GP said.
“We know that when GPs have conversations with their patients about screening, patients trust their advice.
“They want to follow through on it and it, it’s really the thing that makes the biggest difference.
“And then off the back of a positive faecal occult blood test or the screening test, the GP plays a critical role in referring that patient to have a colonoscopy with really a high-quality referral.”
Guidance on comprehensive referrals makes up the first part of the new colonoscopy clinical care standard.
The standard now states that each referral should include an indication, presenting symptoms and the clinical concern, results of previous investigations, all relevant medical and family history, current medicines and previous relevant treatment.
“I think that the standards are very good at emphasising the importance of a quality referral, detailing the patient’s presentation, symptoms, family history and other medical history that’s that may impact in their medications, of course, and communicating all of those details, including previous reports or faecal occult blood tests to the colonoscopist,” Professor Devereaux said.
“But it’s two phases; it’s from the primary care, and then … it’s the receipt by the colonoscopist.
“[The colonoscopist], who could be a physician or a surgeon, [needs] to look at that referral and then determine if it’s appropriate for the patient to have a colonoscopy, and to assess that it’s appropriate for that patient in that it’s a safe procedure for them in the context of their age and their medical history.
“I think that’s a really important piece, and that’s been strengthened in this update of the colonoscopy clinical care standard.”
The other area of importance for gastroenterologists, according to Professor Devereaux, is the final quality statement, which covers reporting and follow up.
The standard now advises doctors to upload the report and results to the patient’s healthcare record and My Health Record where available.
It also encourages reports for patients who underwent a colonoscopy as a result of a positive iFOBT through the National Bowel Cancer Screening Program to be uploaded to the National Cancer Screening Registry.
“It focuses on communication where there is a very clear, accurate report that’s communicated to the referring doctor, all other doctors involved in that patient’s care and the patient,” Professor Devereaux said.
“[It should include] not just why the procedure was done, the indication, the findings, but also the histology, the microscopic assessment of any biopsies, and in particular, of any polyps that were taken.
“And [it also states] that that report is then concluded with the need for either a review, immediate management, or a subsequent surveillance colonoscopy and when that needs to be done, three years, five years, 10 years, and that the patient has been entered into a recall system.
“I think that communication piece at the beginning and the end [of the standard] is really impactful.”
