Key documents

A statement from National Bowel Screening Programme Clinical Director Dr Susan Parry and GP lead Dr John McMenamin.

One of the consequences of increasing awareness about bowel screening appears to be that some people are buying self-testing bowel screening kits, such as those available from pharmacies or from on-line screening services. This may lead to an expectation that asymptomatic individuals, who get a positive result from a self-purchased kit, are entitled to further investigation through the public health system. This is not the case.

We hope the following information is helpful in assisting GPs to clarify the situation regarding commercially available testing kits and manage the expectations of their patients.

In New Zealand, the use of faecal occult blood tests in asymptomatic individuals is not currently recommended nor encouraged, outside the National Bowel screening Programme. This position is endorsed by the National Bowel Cancer Working Group who developed the National Referral Criteria for Direct Access Outpatient Colonoscopy or CT Colonography. This recommendation also applies to the use of self-testing bowel screening kits in asymptomatic individuals.

The reasons for this advice are:

• Screening using self-purchased kits does not include a systematic approach to the screening, diagnosis and treatment. The kits do not provide a diagnosis.
• A positive result from a National Bowel Screening Programme test kit is followed by a free follow up test. This is usually a colonoscopy within a certain time frame. This is generally not available for asymptomatic people who have returned a positive result from test kits purchased and used outside of the programme.
• Beyond their GP, there is no structured or timely support for people who return a positive result. Most will not have cancer but maybe unduly alarmed.
• There is a risk that people with symptoms may be falsely reassured by a negative test result because not all cancers will be detected by a screening test. Repeated testing as part of a structured programme reduces this possibility.
• There is the potential for inequity of access to follow-on investigation for those with a positive result.

Difference between self-purchased and National Bowel Screening Programme-supplied kits

Positivity thresholds can vary between screening programme kits and commercial versions. However, the important difference is that when you get a test kit through the National Bowel Screening Programme, you get the whole package, including a guaranteed free, timely colonoscopy (subject to eligibility for publicly funded healthcare) and follow up treatment, if indicated.

October 2019

Position statement from the National Bowel Screening Programme on reporting test results.

The National Bowel Screening Programme uses a sensitive faecal immunochemical test (FIT) which is designed to detect small amounts of blood in a stool sample (poo).

The National Bowel Screening Programme reports a person’s test result as positive or negative. It does not give the quantitative figure of how much blood was found. However, participants can contact Whakarongorau | National Coordination Centre and request the numerical test result.

Before participating in the programme, potential participants are informed that their FIT result will be reported as either positive or negative. The practice of reporting test results in this way is recommended by the manufacturer of the FIT kit and is consistent with what is done in other countries using the FIT.

How a test result becomes positive or negative

Within New Zealand’s bowel screening programme, a positive result is triggered if the blood (haemoglobin (Hb)) found in a sample is over 200 nanograms of Hb in a millilitre of buffer, the threshold set for the National Bowel Screening Programme. The bowel screening pilot found that readings at this level and higher accounted for 80 percent of bowel cancers found and therefore indicated a higher likelihood of bowel cancer.

There is not enough evidence to precisely calculate the likelihood of bowel disease or cancer for all possible FIT results. For every 100 people with a FIT result above the National Bowel Screening Programme threshold, we know that approximately seven will have a cancer found in the first round of screening. For every 100 people with FIT results below the threshold there will be very few cancers found. Consequently, it is not possible to provide clinical advice to someone without symptoms based on a single quantitative National Bowel Screening Programme FIT result.

The National Bowel Screening Programme continues to report results as positive or negative. Participants with a negative test result, who remain in the eligible age range, are offered a further test every two years, providing further opportunities to detect disease. They are informed that if they notice blood in their bowel motions (poo) or a change in their usual pattern of going to the toilet, they should seek advice from their doctor.

In the screening context, the international screening community is gathering evidence to determine if the actual Hb quantitative level will impact the subsequent screening for an individual.

In the symptomatic setting, based on evidence from the United Kingdom, we are exploring using the FIT in patients with bowel symptoms to determine who would most benefit from proceeding to colonoscopy.

In 2016, Cabinet delegated authority to the Minister of Finance and the Minister of Health to approve National Bowel Screening Programme Business Cases. This is the 2018/19 Business Case. It updates and adds to the National Bowel Screening Programme Business Case approved in August 2016.

• National Bowel Screening Programme 2018/19 Business Case (pdf, 1.7 MB)

March 2019: In 2016, Cabinet delegated authority to the Minister of Finance and the Minister of Health to approve National Bowel Screening Programme Business Cases. This is the Business Case for the National Screening Solution. It sets out how the Ministry will spend the contingency funding set aside in Budget 2016, and therefore updates and adds to the National Bowel Screening Programme Business Case approved in August 2016.

• National Screening Solution Business Case (Warning large file - pdf, 21 MB)

The colonoscopy wait time indicators (CWTI) record the percentage of symptomatic patients (people with visible signs of bowel ill-health) receiving an urgent colonoscopy within 14 days or less (target 90 percent), the percentage of symptomatic patients receiving a non-urgent colonoscopy within 42 days or less (target 70 percent), and the percentage of symptomatic patients receiving a surveillance colonoscopy within 84 days or less (target 70 percent) by district health board (DHB). The Ministry of Health considers CWTI as part of its assessment of a DHB's readiness to join the National Bowel Screening Programme, as a means to measure the DHBs capacity and capability to undertake additional colonoscopies required for a proportion of bowel screening participants.

• Colonoscopy Diagnostic Waiting Time Indicator 3 Month Trend to December 2021 (pdf, 100 KB) (Word 100 KB), - published April 2022
• Colonoscopy Diagnostic Waiting Time Indicator 3 Month Trend to October 2021 (pdf, 100 KB)  (Word, 27 KB) ,  – published January 2022

• Colonoscopy Diagnostic Waiting Time Indicator 3 Month Trend to July 2021 (pdf, 100 KB), 

        (Word, 27 KB) – published January 2022

• Colonoscopy Diagnostic Waiting Time Indicator 3 Month Trend to April 2021 (pdf, 95 KB), 

        (Word, 14 KB) – published June 2021

• Colonoscopy Diagnostic Waiting Time Indicator 3 Month Trend to March 2021 (pdf, 101 KB), 

        (Word, 14 KB) – published May 2021

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to February 2021 (pdf, 97 KB)

        (Word, 27 KB) – published April 2021

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to January 2021 (pdf, 92 KB), 

        (Word, 14 KB) – published March 2021

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to December 2020 (pdf, 92 KB), 

        (Word, 28 KB)  – published February 2021

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to November 2020 (pdf, 142 KB), 

        (Word, 28 KB) – published January 2021

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to September 2020 (pdf, 108 KB), 

        (Word, 98 KB)  – published November 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to August 2020 (pdf, 94 KB), 

        (Word, 14 KB) – published October 2020

• Colonoscopy Diagnostic Wait time Indicator 3 Month Trend to July 2020 (pdf, 95 KB), 

        (Word, 14 KB)  – published September 2020

• Colonoscopy Diagnostic Wait time Indicator 3 Month Trend to June 2020 (pdf, 95 KB), 

        (Word, 14 KB) – published September 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to May 2020 (pdf, 200 KB), 

        (Word, 60 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to April 2020 (pdf, 164 KB), 

         (Word, 33 KB)– published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to March 2020 (pdf, 164 KB), 

        (Word, 32 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to January 2020 (pdf, 164 KB), 

        (Word, 33 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to December 2019 (pdf, 164 KB), 

        (Word, 33 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to November 2019 (pdf, 204 KB), 

        (Word, 28 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to October 2019 (pdf, 204 KB), 

        (Word, 29 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to September 2019 (pdf, 204 KB), 

       (Word, 29 KB) – published July 2020

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to August 2019 (pdf, 198 KB), 

        (Word, 21 KB) – published December 2019

• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to July 2019 (pdf, 943 KB) – published October 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to June 2019 (pdf, 838 KB) – published August 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to May 2019 (pdf, 123 KB) – published July 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to April 2019 (pdf, 126 KB) – published June 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to March 2019 (pdf, 119 KB) – published June 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to February 2019 (pdf, 127 KB) – published June 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to January 2019 (pdf, 258 KB) – published March 2019
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to September 2018 (pdf, 98 KB) – published November 2018
• Colonoscopy Diagnostic Wait Time Indicator 3 Month Trend to June 2018 (pdf, 595 KB) – published October 2018

October 2018: In 2016, Cabinet delegated authority to the Minister of Finance and the Minister of Health to approve National Bowel Screening Programme Business Cases. This is the 2017/18 Business Case. It updates and adds to the National Bowel Screening Programme Business Case approved in August 2016.

• National Bowel Screening Programme 2017/18 Business Case (pdf, 8.6 MB)

September 2018: The publication details the circumstances that led to a group of people eligible for the Bowel Screening Pilot who were not invited when their addresses were updated on the Bowel Screening Pilot register.

• Review of Invitation Issues Following Address Update - Bowel Screening Pilot Programme (Word, 521 KB)
• Review of Invitation Issues Following Address Update - Bowel Screening Pilot Programme (PDF, 1.9 MB)

March 2017: This document sets out the age range and positivity threshold (the threshold which will trigger a positive test result) which have been set for the National Bowel Screening Programme, and explains the decision making processes and evidence behind them.

• Age Range and Positivity Threshold for the National Bowel Screening Programme (docx, 345 KB)

June 2019: The Ministry has produced an updated benefits realisation plan for the National Bowel Screening Programme (NBSP) that lists the benefits of the NBSP, describes how the benefits will be measured and provides the dates of when the benefits will be measured. The NBSP Benefits Realisation Plan v1.2 helps provide information to show the health outcomes for New Zealanders.

• National Bowel Screening Programme Benefits Realisation Plan V1.2 (pdf, 1.13 MB)

August 2016: This Business Case was approved by Cabinet and sets out the justification, proposed approach, timing and cost of procuring a national bowel screening programme and also sets out the local context, proposed approach, timing and costs for the first implementation phase of the national bowel screening programme.

• Executive summary (pdf, 6.9 MB)
• Introduction (pdf, 3.7 MB)
• The strategic case (pdf, 9.29 MB)
• The economic case (pdf, 6.06 MB)
• Commercial case (pdf, 1.98 MB)
• Financial case (pdf, 1.26 MB)
• Management case (pdf, 2.8 MB)
• Tranche 1: Executive summary (pdf, 1.64 MB)
• Tranche 1: Implementation and strategic context (pdf, 5.05 MB)
• Tranche 1: Commercial case, Financial case and Management case (pdf, 3.91 MB)
• Appendices 1-10 (pdf, 9.02 MB)
• Appendices 11-22 (pdf, 5.8 MB)

March 2019: This Health Report seeks the approval of the National Bowel Screening Programme’s National Screening Solution Business Case from the Minister of Finance and the Minister of Health. Approval from both Ministers enabled the Ministry draw down contingency funding set aside in Budget 2016.

• HR20181131 National Screening Solution Business Case (pdf, 5 MB)

October 2018: This is a Health Report seeking the approval of the 2017/18 National Bowel Screening Programme Business Case from the Minister of Finance and the Minister of Health.

• Health Report - Call against National Bowel Screening Programme Business Case tagged contingency 2017/18 (pdf, 930 KB)

July 2018: This Health Report provided information to the Minister of Health about the final report and recommendations of the Independent Assurance Review for the National Bowel Screening Programme.

• Independent Assurance Review for the National Bowel Screening Programme (pdf, 14.5 MB)

June 2018: Between December 2017 and June 2018, the Minister of Health regularly met Ministry officials to discuss the National Bowel Screening Programme. This is the June 2018 Health Report.

• NBSP Minister’s meeting 11 June 2018 (pdf, 2.7 MB)

May 2018: This Health Report provided an update to the Minister of Health about coding issues in the bowel screening pilot.

• Coding issues (pdf, 630 KB)

April 2018: Between December 2017 and June 2018, the Minister of Health regularly met Ministry officials to discuss the National Bowel Screening Programme. This is the April 2018 Health Report.

• NBSP Minister’s meeting 30 April 2018 (pdf, 2.9 MB)

April 2018: This Health Report briefed the Minister prior to a meeting with Associate Professor Michael Schultz, President of the New Zealand Society of Gastroenterology.

• Meeting with NZ Society of Gastroenterology (pdf, 9.4 MB)

April 2018: This Health Report provided an update to the Minister of Health about the invitation issues in the bowel screening pilot.

• Invitation issues (pdf, 711 KB)

March 2018: Between December 2017 and June 2018, the Minister of Health regularly met Ministry officials to discuss the National Bowel Screening Programme. This is the March 2018 Health Report (there was no February meeting).

• NBSP Minister’s meeting 19 March 2018 (pdf, 726 KB)

February 2018: These Health Reports provided advice to the Minister of Health about potential reviewers to sit on the Independent Assurance Review for the National Bowel Screening Programme.

• Advice on independent expert reviewers (pdf, 1015 KB)
• Advice on independent expert reviewer (pdf, 794 KB)

February 2018: This Health Report provided further information to the Minister of Health about how potential participants in the bowel screening pilot had not been invited, and discussed the commissioning of the Independent Assurance Review for the National Bowel Screening Programme.

• Independent Assurance Review for the National Bowel Screening Programme and further information on the ‘address override’ issue (pdf, 607 KB)

January 2018: Between December 2017 and June 2018, the Minister of Health regularly met Ministry officials to discuss the National Bowel Screening Programme. This is the January 2018 Health Report.

• NBSP Minister’s meeting 30 January 2018 (pdf, 1.6 MB)

January 2018: The Ministry of Health provided the Minister of Health with a briefing outlining the timing of the NBSP implementation.

• NBSP Timeline (pdf, 597 KB)

January 2018: The Ministry of Health provided the Minister of Health with a briefing explaining the two tests available for bowel screening and why the FIT was chosen.

• NBSP Faecal Immunochemical Test (FIT) and Flexible Sigmoidoscopy (pdf, 2.7 MB)

December 2017: The Ministry of Health provided the Minister of Health with copies of two independent reports about information technology (IT) systems to support the development of the NBSP National Screening Solution. The reports were provided as attachments.

• Copy of Accenture and EY (IT) Reports (pdf, 2.9 MB)
• Accenture report (pdf, 1.7 MB)
• EY report (pdf, 10 MB)

March 2017: A Health Report drafted by Ministry officials to Hon Dr Jonathan Coleman, Minister of Health. This report provided a Cabinet paper to be signed and submitted to the Cabinet State Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 22 March 2017.

• Cabinet Paper – National Bowel Screening Programme Progress (pdf, 2.85 MB)

February 2017: A Health Report drafted by Ministry officials to Hon Dr Jonathan Coleman, Minister of Health. This report provided a Cabinet paper to be signed and submitted to the Cabinet State Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 8 February 2017.

• Cabinet Paper - National Bowel Screening Programme Extension of Capital Contingency (pdf, 3.08 MB)

August 2016: A Health Report drafted by Ministry Officials to Hon Dr Jonathan Coleman, Minister of Health. This report provided a Cabinet paper to be signed and submitted to the Cabinet Sate Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 24 August 2016.

• Key points Cabinet Paper - Bowel Screening in New Zealand - Next Steps (pdf, 2.03 MB)

November 2015: A Health Report drafted by Ministry Officials to Hon Dr Jonathan Coleman, Minister of Health. This report provided a Cabinet paper on consultation on a national bowel screening programme to be signed and submitted to the Cabinet Social Policy Committee for their consideration on 2 December 2015.

• Progress towards a National Bowel Screening Programme for New Zealand (pdf, 74 KB)

December 2017: A Health Report drafted by Ministry officials to Hon Dr David Clark, Minister of Health. This report provided a Cabinet paper to be signed and submitted to the Cabinet Business Committee (CBC) for their consideration on 20 December 2017.

• Cabinet Paper – National Bowel Screening programme Extension of Capital Contingency (pdf, 3.8 MB)

December 2017: Between December 2017 and June 2018, the Minister of Health regularly met Ministry officials to discuss the National Bowel Screening Programme. This is the December 2017 Health Report.

• NBSP Minister’s meeting 4 December 2017 (pdf, 720 KB)

November 2017: This Health Report provided the first update to the Minister of Health and further information about the eligible participants in the bowel screening pilot who had not been invited to participate.

• Withdrawal of eligible people in the bowel screening pilot (pdf, 745 KB)
• Communications plan: Issue relating to address updates in bowel screening registers (pdf, 686 KB)

November 2017: In November 2017, the Ministry of Health provided the Minister of Health with a comprehensive briefing about the National Bowel Screening Programme.

• NBSP Operational Matters (pdf, 3.4 MB)

November 2017: This Health Report told the Minister of Health that some eligible participants in the bowel screening Pilot had not been invited to participate.

• Bowel screening pilot’s incorrect withdrawal of eligible people (pdf, 3.3 MB)

October 2017: This Health Report provided an overview of the National Bowel Screening Programme to the Minister of Health ahead of an interview on Morning Report (Radio New Zealand).

• Briefing on NBSP for Morning Report on 1 November 2017 (pdf, 539 KB)

December 2017: The Cabinet Business Committee (CBC) paper presented by Hon Dr David Clark, Minister of Health on 20 December 2017. This Cabinet paper sought agreement to extend the Budget 2016 capital contingency until December 2018, and noted the information technology procurement process.

• National Bowel Screening programme Extension of Capital Contingency (pdf, 219 KB)
• National Bowel Screening programme Extension of Capital Contingency (docx, 55 KB)

Public Sector Agencies are required to complete Cost Benefit Analysis Templates as part of the Budget process for the Treasury. This document organises key information in a logical and methodical way. A Cost Benefit Analysis measures the impact of a decision on the public at large. This is the Budget 2017 submission for the National Bowel Screening Programme.

• National Bowel Screening Programme - Cost Benefit Analysis Template (pdf, 319 KB)

March 2017: A Cabinet paper presented by Hon Dr Jonathan Coleman, Minister of Health presented to Cabinet Sate Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 22 March 2017. This paper provided a progress update on implementing the National Bowel Screening Programme and sought approval to extend the development of the national information technology solution for up to a year.

• National Bowel Screening Programme Progress (pdf, 1.02 MB)

February 2017: A Cabinet paper presented by Hon Dr Jonathan Coleman, Minister of Health presented to Cabinet Sate Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 8 February 2017. This paper sought approval to extend the Budget 2016 capital contingency until February 2018.

• National Bowel Screening Programme Extension of Capital Contingency (pdf, 2.99 MB)

August 2016: A Cabinet Paper presented by Hon Dr Jonanthan Coleman, Minister of Health to the Cabinet Sate Sector Reform and Expenditure Control Cabinet Committee (SEC) for their consideration on 24 August 2016. This paper sought committee approval of the Business Case for a national bowel screening programme and the time frames required for a full national roll-out.

• Bowel Screening in New Zealand - Next Steps (pdf, 6.86 MB)

November 2015: A Cabinet Paper presented by Hon Dr Jonathan Coleman, Minister of Health to the Cabinet Social Policy Committee for their consideration on 2 December 2015. This paper asked the Committee to note the outcomes of health sector consultation on a national bowel screening programme and the Ministry of Health is preparing a business case which will be submitted to Ministers in February 2016 as part of final Budget 2016 considerations.

• Progress towards a national bowel screening programme for New Zealand (pdf, 352 KB)

October 2018: Public Sector Agencies are required to complete Budget Initiative Summary Templates as part of Budget process for the Treasury. This document is a high level summary of of the National Bowel Screening Programme initiative included in Budget 2016.

• Budget Initiative Summary Template: National Bowel Screening Programme (pdf, 3.39 MB)

December 2017: A copy of the Cabinet Business Committee (CBC) Minute dated 20 December 2017 approving Hon Dr David Clark, Minister of Health’s request to extend the Budget 2016 capital contingency until December 2018.

• Cabinet Business Committee Minute National Bowel Screening programme Extension of Capital Contingency (pdf, 644 KB)

February 2017: A copy of the Cabinet Social Policy Committee (SOC) Minute dated 8 February 2017 approving Hon Dr Jonathan Coleman, Minister of Health request to extend the Budget 2016 capital contingency until February 2018.

• Cabinet minutes - National Bowel Screening Programme Extension of Capital Contingency (pdf, 765 KB)

March 2016: A copy of the Cabinet Minute

• Cabinet minutes - National Bowel Screening Programme Progress (pdf, 116 KB)

October 2015: Public Sector Agencies are required to complete Cost Benefit Analysis Templates as part of the Budget process for the Treasury. This document organises key information in a logical and methodical way. A Cost Benefit Analysis measures the impact of a decision on the public at large.

• Cost Benefit Analysis Template: National Bowel Screening Programme (pdf, 5.9 MB)

May 2023

August 2020

This tool was designed to help provide data on bowel screening participation rates across Aotearoa New Zealand.  

It features an interactive map and a brief explanation of this programme measure. It allows the participation rate data to be stratified by ethnicity, age, and gender.  

Due to the six-month time frame that participants are given to complete and return the kit, there is a six-month time lag for participation rate numbers. 

View the bowel screening participation data tool

October 2018

September 2018

July 2017

This quick reference guide will help general practitioners and practice nurses discuss and manage positive test results with their patients.

Surveillance and management of groups at increased risk of colorectal cancer (1.1 MB)

1998

Working party population screening for CRC (776 KB)

November 2006

CRC report NSU working party (806 KB)