This recommendation does not apply to people with a bowel symptom such as bleeding. Approximately 98% of Australians are at ‘average’ or ‘slightly above average’ risk (e.g. one relative with bowel cancer diagnosed at ≥ 55yo).

RACGP guidelines recommend two-yearly faecal occult blood testing (FOBT) from 50-75 years of age. The best available data to 2011 suggests 13% of this group were instead over-screened using colonoscopy.

National Bowel Cancer Screening Program (NBCSP) data shows that, per 10,000 people in this group followed up for an average 18 months, 6 will die from bowel cancer if unscreened. If screened with colonoscopy, 2.3 will die (1.5 from bowel cancer plus 0.8 from colonoscopy complications), compared to just 1.9 deaths for FOBT. A colonoscopy also risks bowel perforation (7 per 10,000), involves bowel preparation, and costs around $3000. NBCSP monitoring shows that a negative FOBT is 99.9% specific in ruling out bowel cancer.

Recommendation released March 2016

Supporting evidence

  • RACGP, Red Book Taskforce. Guidelines for preventive activities in general practice. Royal Australian College of General Practitioners: Melbourne (2012). Available from:  http://www.racgp.org.au/your-practice/guidelines/redbook/early-detection-of-cancers/colorectal-cancer-%28crc%29/
  • Ouakrim DA et al. Screening practices of Australian men and women categorized as ‘‘at or slightly above average risk’’ of colorectal cancer. Cancer Causes Control 2012;23:1853–1864. (The 13% figure taken from the latest, unpublished data, received via correspondence from the primary author, Oct 2015).
  • Emery J. NHMRC Centre for Research Excellence for Optimising Colorectal Cancer Screening at the University of Melbourne. AIHW data, National Bowel Cancer Screening Program.
  • Viiala CH, et al. Complication rates of colonoscopy in an Australian teaching hospital environment. Internal Medicine Journal 2003;33:355-9.
  • Australian Institute of Health and Welfare. Analysis of bowel cancer outcomes for the National Bowel Cancer Screening Program. 2014 Canberra: AIHW cat. no. CAN 87. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549722

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Acute bronchitis is the commonest cause of cough presenting to GPs. It is usually viral (>90%) and self-limiting, and antibiotics should not routinely be used.

Chest x-rays (CXRs) are the imaging tests most frequently ordered by Australian GPs, and the most common indication is acute bronchitis/bronchiolitis (140,000 annually, data combined for both conditions).

‘Uncomplicated’ bronchitis refers to cough and sputum lasting less than three weeks in immunocompetent patients without underlying respiratory disease, and no clinical features suggesting pneumonia (heart rate >100, resp rate >24, temp >38.0C, haemoptysis, signs of consolidation). A Cochrane review found routine CXR did not affect outcomes in adults or children presenting to hospital with acute chest infection. Note that purulent (green) sputum is not predictive of bacterial infection and is not in itself an indication for CXR. CXRs may also lead to false positives, further investigation and unnecessary radiation. The threshold for CXR should be lower in patients over 60.

Recommendation released March 2016

Supporting evidence

  • Gordon J, Miller G, Pan Y. Ordering chest X-rays in Australian general practice. Aust Fam Physician 2015;44:537-9.
  • Michigan Quality Improvement Consortium. Management of uncomplicated acute bronchitis in adults. Southfield (MI): Michigan Quality Improvement Consortium; 2012 Sep. 1.
  • Metlay J, Kapoor W, Fine M. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278(17):1440-45.
  • Cao A, Choy J, Mohanakrishnan L, et al. Chest radiographs for acute lower respiratory tract infections. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.:CD009119.
  • Albert A. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010;1:82(11).

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During a routine cervical smear (Pap test) for screening (i.e. no symptoms), a bi-manual pelvic examination has no proven benefit, as it has not been shown to improve the detection of ovarian cancer or to benefit other outcomes. In a large study of Australian women undergoing routine screening pelvic examination, no ovarian malignancies were found, and the high prevalence of benign abnormalities (bulky/fibroid uterus in 13%, abnormal adnexal findings in 2%) often led to further investigation.

A recent US review concluded that no data supports the effectiveness of speculum or bimanual pelvic examinations in the asymptomatic, average-risk woman. The procedure causes pain, fear, anxiety, and/or embarrassment in a third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures. Pelvic examinations require additional clinician time and, for consultations not otherwise requiring intimate examination, the consideration of a chaperone. Therefore, unnecessary examinations lead to resource and opportunity costs.

Recommendation released March 2016

Supporting evidence

  • Grover SR, Quinn MA. Is there any value in bimanual pelvic examination as a screening test? Med J Aust 1995;162(8):408-10.
  • Ebell MH, Culp M, Lastinger K, Dasigi T. A systematic review of the bimanual examination as a test for ovarian cancer. Am J Prev Med 2015;48(3):350-6.
  • Simms I, Warburton F, Weström L. Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect 2003;79(6):491-4.
  • Bloomfield HE, Olson A, Cantor A, et al. Screening Pelvic Examinations in Asymptomatic Average Risk Adult Women [Internet]. Washington (DC): Department of Veterans Affairs; 2013 Sep. http://www.ncbi.nlm.nih.gov/books/NBK224896/

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Avoid the routine use of antibiotics in acute otitis media (middle ear infection), except in a child with acute systemic features such as high fever, vomiting or lethargy. Clinical review at 24-48 hours is good practice, if available. Regardless of whether one or both eardrums are red or bulging, antibiotics do not reduce pain at 24 hours, and up to 20 children must be treated to prevent pain in one child at 2 to 7 days. Routine antibiotic use slightly reduces tympanic membrane perforation (NNT = 33) but has no effect on tympanic membrane findings at 3 months, nor on severe complications.

One in 14 children will develop antibiotic side effects, particularly rash, diarrhoea, or vomiting. Antibiotic use promotes bacterial resistance, both in the individual and community. Aboriginal and Torres Strait Islander children are at higher risk of complications and should be treated early. Guidelines vary about the value of antibiotic treatment in children aged 6-23 months, but support antibiotics for infants under 6 months.

Recommendation released March 2016

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This ‘screening’ recommendation does not apply to people with symptoms suggestive of thyroid disease. The prevalence in adults of subclinical hypothyroidism is about 4.3% (0.7% for subclinical hyperthyroidism), and prevalence is higher in older adults and women. About 2-5 percent of people with subclinical hypothyroidism and 1-2 percent with subclinical hyperthyroidism will develop overt thyroid disease per year.

However, many patients with subclinical thyroid dysfunction revert to normal when followed over time. A 2014 systematic review of screening for thyroid dysfunction found that clear evidence on the benefits and harms of screening is unavailable, and recommended against population-based screening. In the absence of evidence that early treatment reduces symptoms, lipid levels, or the risk of cardiovascular disease in patients with mild thyroid dysfunction detected by screening, the RACGP Guidelines for preventive activities in general practice does not recommend screening for thyroid disease in asymptomatic populations.

Recommendation released March 2016

Supporting evidence

  • RACGP, Red Book Taskforce. Guidelines for preventive activities in general practice. Royal Australian College of General Practitioners: Melbourne (2012). Available from: http://www.racgp.org.au/your-practice/guidelines/redbook/screening-tests-of-unproven-benefit/
  • Rugge JB, Bougatsos C, Chou R. Screening for and Treatment of Thyroid Dysfunction: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 118. AHRQ Publication No. 15-05217-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.
  • Ochs N, Auer R, Bauer DC. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med 2008;148(11):832–45.  

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Last reviewed 27 June 2016