Christou et al. BMC Public Health 2010, 10:373 http://www.biomedcentral.com/1471-2458/10/373 R E S E A R C H A R T I C L E Open Access Australia’s National Bowel Cancer Screening Program: does it work for Indigenous Australians? Aliki Christou1*†, Judith M Katzenellenbogen1, Sandra C Thompson1,2† Abstract Background: Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population. This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups. Methods: A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions. Results: The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening. Conclusions: Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening. Background Australia has one of the highest rates of bowel cancer in the world [1]. It is currently the second most commonly diagnosed cancer in men and women, and the third leading cause of cancer-related deaths in the country [2]. While mortality from bowel (also known as colorec- tal) cancer in the general population has declined in recent years, the situation among Aboriginal and Torres * Correspondence: alikichristou@yahoo.com.au † Contributed equally 1Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia Strait Islanders (hereafter Indigenous) is not so encoura- ging, with some data showing that bowel cancer is increasing as a significant cause of premature death [3,4]. Similar patterns have been observed in Indigenous populations across the world including Inuit and First Nations in Canada and Maori in New Zealand (N.Z), generally attributed to an increasingly westernised life- style [5-7]. Cancer screening aims to identify unrecognized dis- ease in individuals at average risk who are asympto- matic. Only 40% of bowel cancers are detected in their early stages primarily because very few if any symptoms © 2010 Christou et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.