Australia's colonoscopy access gap widens, report reveals

There is a growing disparity in colonoscopy rates according to where people live and their socioeconomic status, data in a new Australian Commission on Safety and Quality in Health Care (the Commission) report suggests. A vital tool to prevent and detect bowel cancer, colonoscopy is recommended after a positive bowel cancer screening test or key symptoms, with Australians undergoing around one million colonoscopies each year.

To rule out potential bowel problems, for some only one colonoscopy may be needed, while repeat colonoscopies may be needed for others — to monitor the large bowel (colon) for cancer risk or recurrence. Only a small proportion of people need a repeat colonoscopy before three years, if Cancer Council guidelines are followed, and previous results and risk factors affect timing of a repeat colonoscopy.

However, according to findings in the Commission’s Atlas Focus Report: Colonoscopy, some people may be having repeat colonoscopies too soon, while others may be missing out on colonoscopies altogether. Bowel cancer is Australia’s fourth most commonly diagnosed cancer, with an annual cost of $1.7 billion — and while bowel cancer survival rates continue to improve, mortality rates are higher outside major cities and in lower socioeconomic areas, with colonoscopy rates being consistently lower in these areas.

“The Atlas Focus Report highlights a widening gap in colonoscopy rates,” said Conjoint Professor Anne Duggan, CEO of the Commission and a gastroenterologist. “People living in cities and more affluent areas are having more MBS-subsidised colonoscopies than those in both rural and disadvantaged areas.”

The report examines MBS-subsidised¹ rates of colonoscopy and repeat colonoscopy before three years, with some findings including that there was an 8% decrease in the past decade to 2023–24 of the national rate of repeat colonoscopy before three years, and that rates fell the most in remote areas (down 26%) and areas of most socioeconomic disadvantage (down 17%).

Regarding overall colonoscopy rates in 2023–24, these were four times as high in major cities than remote areas (2550 compared with 633 per 100,000 people) and rates in more affluent areas were nearly double those in areas of most socioeconomic disadvantage (3067 compared with 1675 per 100,000 people). “Colonoscopy is one of the most powerful tools to prevent and detect bowel cancer early,” Duggan said. “We want to make sure every colonoscopy is done for the right reason, at the right time and to the highest quality.”

Updated Colonoscopy Clinical Care Standard

Also launched this month is an updated Colonoscopy Clinical Care Standard (2025), which provides the latest guidance to ensure procedures are safe and high quality. Mandatory for health services, the updated standard emphasises following guidelines on who needs colonoscopy, with key changes in the standard addressing difficulties in accessing previous results that can lead to confusion and, at times, unnecessary repeat colonoscopy. The standard advises better communication at referral and sharing of reports with patients and GPs, plus in My Health Record.

You can read the report here and the standard is available here, via the Commission’s website.

_{1. Interactive national trend data on Medicare Benefits Scheme (MBS) subsidised colonoscopy and repeat colonoscopy use, 2013–14 to 2023–24}

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