Released late last week by the Ministry of Health, the document says the programme would generate 8300 colonoscopies per year, almost a fifth of all colonoscopies.
Only three of 20 district health boards said they could provide the programme within existing facilities. Boards requiring building work would need to apply to a national capital investment committee, but they were encouraged to look to the private sector or other boards first.
The cost of the screening would partly come out of DHBs' existing budgets. Financial detail, including predicted financial benefits, has been heavily redacted by officials.
Even including the private sector, colonoscopy capacity was limited, the document admits.
``Implementation in some DHBs cannot occur until adequate capacity is available.''
The programme, which would detect up to 700 cancers per year, could involve up to 700,000 people aged 60 to 74 over a two-year cycle. A 62% participation rate was expected.
The programme would benefit some groups more than others.
Maori, Pacific Island, and poor people were less likely to take part, and would thus not reap as much benefit.
``Maori have lower incidence of colorectal cancer, higher background mortality and are likely to have lower screening coverage compared to non-Maori. This would almost certainly result in an increased disparity in cancer outcomes.''
Bowel cancer is one of the few cancers for which Maori had a lower incidence. However, once diagnosed, Maori had a higher risk of death.
Efforts would be made to maximise participation in these groups.
Four regional centres would be selected to manage the colonoscopies, and an IT system would need to be set up.
To manage colonoscopy demand, the trigger for a colonoscopy had been loosened from 75 haemoglobin per ml of blood in the Waitemata DHB pilot scheme, to 200 haemoglobin per ml.
The national screening advisory committee has recommended that GPs are able to tell patients their particular score, rather than just a positive or negative result, the document notes.
Changing the threshold had cut in half the number of estimated colonoscopies. The higher level was comparable with other countries.
Southern is one of nine DHBs scheduled to start screening in early 2018.
An assessment carried out by the Southern District Health Board released to the Otago Daily Times last month shows the board's requirements.
The board estimates it would need additional theatre and ward staff, and increased endoscopy access in Southland. In Dunedin, a new endoscopy suite being built will handle demand. It will be completed early next year.
Mercy Hospital clinical services director Philippa Pringle confirmed the private hospital had attended Ministry of Health meetings in Christchurch held as part of the planning.
Mercy would be able to provide part of the programme, if required, but Mrs Pringle said the southern board wanted it kept in-house.
``They are quite keen to do it on their own, as I understand it.''
Dunedin North MP David Clark said the Government should disclose the financial costs and benefits of the programme. Much remained unclear about how the health sector would cope, he said.
``It all looks like wishful thinking at this stage.
``The health system is absolutely creaking.'' Dr Clark said.
Bowel cancer screening
- 700,000 people eligible in two-year cycle.
- Bowel cancer the second-most common cause of cancer death after lung cancer.
- Screening detects cancer at early, treatable stage.
- Expected to save money, eventually, but uncertainty remains how sector will cope.
- Will detect 500-700 cancers per year
- Nationwide screening will be set to less sensitive level than in the Waitemata DHB pilot.
- Four regional bowel screening centres to be selected.
