Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

Eleonora Feletto*, Jie-Bin Lew, Joachim Worthington, Emily He, Michael Caruana, Katherine Butler, Harriet Hui, Natalie Taylor, Emily Banks, Karen Barclay, Kate Broun, Alison Butt, Rob Carter, Jeff Cuff, Anita Dessaix, Hooi Ee, Jon Emery, Ian M. Frayling, Paul Grogan, Carol HoldenChristopher Horn, Mark A. Jenkins, James G. Kench, Maarit A. Laaksonen, Barbara Leggett, Gillian Mitchell, Susan Morris, Bonny Parkinson, D. James St John, Linda Taoube, Katherine Tucker, Melanie A. Wakefield, Robyn L. Ward, Aung Ko Win, Daniel L. Worthley, Armstrong Bruce K., Finlay A. MacRae, Karen Canfell

*Corresponding author for this work

Research output: Contribution to journalArticle

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Introduction: With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods.

Methods and analysis: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments.

Ethics and dissemination: Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.

Original languageEnglish
Article numbere036475
Pages (from-to)1-9
Number of pages9
JournalBMJ Open
Issue number6
Publication statusPublished - 21 Jun 2020

Bibliographical note

Copyright Author(s) (or their employer(s)) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • colorectal cancer
  • early detection
  • prevention
  • screening


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