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National Cancer Institute®
Ultima Vez Modificado: 21 de noviembre del 2001
UI - 21369646
AU - Pesce A
TI - Selections from current literature. Colorectal cancer screening.
SO - Fam Pract 2001 Aug;18(4):457-60
AD - Department of Family Medicine, Health Sciences Center, L-4, SUNY at Stony Brook School of Medicine, Stony Brook, NY 11794, USA.
UI - 21436643
AU - Giorgi R; Gouvernet J; Dufour J; Degoulet P; Laugier R; Quilichini F;
TI - Fieschi M Elaboration and formalization of current scientific knowledge of risks and preventive measures illustrated by colorectal cancer.
SO - Methods Inf Med 2001;40(4):323-30
AD - Laboratoire d'Enseignement et de Recherche sur le Traitement de l'Information Medicale (LERTIM), Faculte de Medecine, Universite de la Mediterranee, Marseille, France. email@example.com
OBJECTIVES: Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures. METHODS: The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines. RESULTS: The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach. CONCLUSIONS: Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.
UI - 21271475
AU - Yoshinaga M; Watabe R; Yanagisawa J; Harada N; Motomura S; Nawata H;
TI - Ikeda K The interval between flexible sigmoidoscopy screening examinations can be expanded beyond five years.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):437-9
AD - Department of Internal Medicine, Fukuoka Teishin Hospital, 2-6-11 Yakuin, Fukuoka 810-8798, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: As one of the methods for colorectal cancer screening, asymptomatic average-risk persons aged > or = 50 years are recommended to undergo flexible sigmoidoscopy screening every 5 years. We evaluate whether the interval between examinations can be extended beyond 5 years. METHODOLOGY: A total of 192 asymptomatic average-risk subjects were studied, all of whom had undergone a initial negative examination on a flexible sigmoidoscopy screening at age > or = 50 years and a second examination at least 3 years later. The study population was divided into three groups according to the interval between examinations, which was 3-5 years in Group A, 5-6 years in Group B, and 6-8 years in Group C. RESULTS: The incidence of neoplasms was compared among the three subjects groups, and it was found to be similar: 11/96 (11.5%) in group A, 4/55 (7.3%) in group B, and 5/41 (12.2%) in group C. All detected adenomas were less than 10 mm in diameter, and none contained a villous component or high-grade dysplasia. No cancers were found in the study. CONCLUSIONS: The results suggest that the interval for screening sigmoidoscopy may be extended beyond 5 years in persons showing negative results on an initial examination.
UI - 21287873
AU - Camma C; Giunta M; Andreone P; Craxi A
TI - Interferon and prevention of hepatocellular carcinoma in viral cirrhosis: an evidence-based approach.
SO - J Hepatol 2001 Apr;34(4):593-602
AD - Istituto Metodologie Diagnostichie Avanzate, Consiglio Nazionale delle Ricerche, Palermo, Italy. email@example.com
BACKGROUND/AIMS: To evaluate by meta-analysis of available literature whether interferon (IFN) reduces the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C virus (HCV)-related Child A cirrhosis. METHODS: Three randomized controlled trials and 15 nonrandomized controlled trials, including 4614 patients and comparing IFN to no treatment, were selected. Data on the incidence of HCC in IFN treated and untreated patients were extracted from each study. Meta-analysis by the DerSimonian and Laird risk difference (RD) method was used to pool observations. RESULTS: A different incidence of HCC between treated and untreated cirrhotic patients was observed for HCV (overall RD -12.8%; 95% CI -8.3 to -17.2%, P < 0.0001) and HBV (overall RD -6.4%; 95% CI -2.8 to -10%, P < 0.001). In HCV-related cirrhosis, the rate of HCC development was lower in sustained responders to IFN than in untreated patients (overall RD -19.1%; 95% CI -13.1 to -25.2%, P < 0.00001), with low heterogeneity among trials (P=0.053), and also in nonresponders vs. untreated patients (overall RD -11.8%; 95% CI -6.4 to -19.1%, P < 0.0001), although with significant heterogeneity. Inconsistency among the studies was a major problem, both for HCV (chi2 = 58.16 with 13 DF; P < 0.0001) and HBV (chi2 = 26.4 with 6 DF; P = 0.0001) related cirrhosis, and also when follow-up was shorter than 60 months. Consistent results were only observed when assessing data from European reports: in this subgroup no preventive effect of HCC was shown for HBV (overall RD -4.8%; 95% CI -11.1-1.5%, P, not significant), and only a weak effect for HCV (overall RD -10%; 95% CI -5.9 to -14.2%; P < 0.0001). CONCLUSIONS: Literature data pooling suggests a slight preventive effect of IFN on HCC development in patients with HCV-related cirrhosis. The magnitude of this effect is low and the observed benefit might be due to spurious associations. The preventive effect is more evident among sustained responders to IFN. IFN does not seem to affect the rate of HCC in HBV-related cirrhosis.
UI - 21381292
AU - Feldman RA
TI - Review article: would eradication of Helicobacter pylori infection reduce the risk of gastric cancer?
SO - Aliment Pharmacol Ther 2001 Jun;15 Suppl 1():2-5
AD - The Royal London Hospital, Whitechapel Road, London E1 1BB, UK. firstname.lastname@example.org
This article reviews the data on the epidemiology of gastric cancer, to determine if treatment of an asymptomatic individual can be justified. It reviews retrospective and prospective case-control studies of gastric cancer in Italy and other countries. Mucosa-associated lymphoid tissue lymphoma is associated with Helicobacter pylori infection. The risk of noncardia gastric cancer is higher (4-fold or greater) in those with H. pylori infection. Although no studies have shown prevention following treatment, eradication of asymptomatic H. pylori infection in an individual in the age group 40 or lower may be expected to reduce the risk of gastric cancer.
UI - 21436668
AU - van Veen WA
TI - [National colorectal carcinoma screening program deserves further study; a report from the Dutch Health Council]
SO - Ned Tijdschr Geneeskd 2001 Aug 25;145(34):1655-7
AD - email@example.com
Each year there are about 8400 new colorectal carcinoma (CRC) cases in the Netherlands. Despite improved treatment possibilities the mortality rate has not shown a decline. A reduction in the mortality rate can be achieved by screening for CRC by means of faecal occult-blood testing. Endoscopic screening (flexible sigmoidoscopy or colonoscopy) could reduce not only the mortality but also the incidence of CRC, but this has yet to be conclusively demonstrated. The introduction of a national screening programme deserves serious consideration, although various questions need to be answered before a final decision can be taken. These concern the optimal screening strategy, the expected degree of participation, the follow-up under persons in whom polyps are found, the demand on human resources and other resources, and the cost-effectiveness.
UI - 21458875
AU - Okuno M; Sano T; Matsushima-Nishiwaki R; Adachi S; Akita K; Okano Y;
TI - Kojima S; Moriwaki H Apoptosis induction by acyclic retinoid: a molecular basis of 'clonal deletion' therapy for hepatocellular carcinoma.
SO - Jpn J Clin Oncol 2001 Aug;31(8):359-62
AD - First Department of Internal Medicine, Gifu University School of Medicine, Gifu, Japan.
We have shown previously that administration of acyclic retinoid to cirrhotic patients who had undergone curative treatment of preceding hepatocellular carcinoma (HCC) induced the disappearance of serum lectin-reactive alpha-fetoprotein (AFP-L3) and subsequently reduced the incidence of second liver cancers. AFP-L3 is a tumor marker that indicates the presence of occult tumors below the detection limit by diagnostic images. Therefore, we have proposed a new concept of 'clonal deletion' therapy with acyclic retinoid for the cancer chemoprevention against HCC. Such eradication of AFP-L3-producing latent malignant (or premalignant) cells from the liver suggested a new strategy to prevent HCC, which may be involved in the same category as cancer chemotherapy. In the present series of studies, we explored the molecular mechanism of 'clonal deletion' and found a novel mechanism of apoptosis induction by the retinoid. We have demonstrated a modification of a retinoid receptor, RXRalpha, by mitogen-activated protein (MAP) kinase-dependent phosphorylation, resulting in the loss of transactivating activity. This may lead HCC cells to be resistant to natural retinoic acid. However, acyclic retinoid restored the function of phosphorylated RXRalpha and induced its downstream pro-apoptotic genes including tissue transglutaminase, an enzyme that is implicated in apoptosis. Tissue transglutaminase-dependent apoptosis in HCC cells was independent of the activation of caspases. This novel mechanism of retinoid-induced apoptosis may give a clue to understand the molecular mechanism of clonal deletion.
UI - 21349663
AU - Shapiro JA; Seeff LC; Nadel MR
TI - Colorectal cancer-screening tests and associated health behaviors.
SO - Am J Prev Med 2001 Aug;21(2):132-7
AD - Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
BACKGROUND: Studies have shown that screening reduces colorectal cancer mortality. We analyzed national survey data to determine rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if these rates differ by demographic factors and other health behaviors. METHODS: A total of 52,754 respondents aged >or=50 years were questioned in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a random-digit-dialing telephone survey of the non-institutionalized U.S. population) about their use of FOBT and sigmoidoscopy. RESULTS: The age-adjusted proportion of respondents who reported having had a colorectal cancer screening test during the recommended time interval (past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or sigmoidoscopy. Rates of use of colorectal cancer screening tests were higher for those who had other screening tests (mammography, Papanicolaou smear, and cholesterol check). There were also differences in rates of use of colorectal cancer screening tests according to other health behaviors (smoking, seat belt use, fruit and vegetable intake, and physical activity) and several demographic factors. However, none of the subgroups that we examined reported a rate of FOBT use above 29% within the past year or a rate of sigmoidoscopy use above 41% within the past 5 years. CONCLUSIONS: While rates of use of FOBT and sigmoidoscopy were higher among people who practiced other healthy behaviors, rates of use were still quite low in all subgroups. There is a need for increased awareness of the importance of colorectal cancer screening.
UI - 21454922
AU - O'Malley MS; Shaheen NJ; Crosby MA; Murray SC; Klenzak JS; Galanko JA;
TI - Singla A; Ransohoff DF; Sandler RS; Gaither J; Paskett ED Colorectal cancer screening in North Carolina. Community clinicians' perspectives.
SO - N C Med J 2001 Sep-Oct;62(5):292-7
AD - UNC Lineberger Comprehensive Cancer Center, CB#7295, Chapel Hill, NC 27599-7295, USA. firstname.lastname@example.org
UI - 21454923
AU - Conlisk E
TI - Colorectal cancer in North Carolina. Risk factors, screening behaviors, incidence, stage at diagnosis, and mortality.
SO - N C Med J 2001 Sep-Oct;62(5):298-303
AD - Faculty of the School of Natural Science, Hampshire College, Amherst, MA 01002, USA. email@example.com
UI - 21459262
AU - Fitzgerald RC; Saeed IT; Khoo D; Farthing MJ; Burnham WR
TI - Rigorous surveillance protocol increases detection of curable cancers associated with Barrett's esophagus.
SO - Dig Dis Sci 2001 Sep;46(9):1892-8
AD - Havering Hospitals NHS Trust, Romford, Essex, UK.
Esophageal adenocarcinoma is increasing in incidence and has a high mortality unless detected early. Barrett's esophagus is the only known risk factor for this cancer; however, whether endoscopic surveillance reduces morbidity and mortality is controversial. Endoscopic cancer surveillance programes for Barrett's esophagus are not routinely practiced in the UK, and this is the first study to examine whether a rigorous surveillance protocol increases the detection rate of early oesophageal cancer. All patients with a diagnosis of Barrett's esophagus or associated adenocarcinoma attending Havering Hospitals NHS Trust between 1992 and 1998 were included. A retrospective analysis was made of patients undergoing informal surveillance (96 patients, 1992-1997) and a prospective analysis was conducted following the implementation of a rigorous protocol (108 patients, 1997-1998). Over the same time periods Barrett's associated cancers diagnosed in patients not undergoing surveillance were analyzed (262 patients 1992-1997, 98 patients 1997-1998). From 1992 to 1997, one case of high-grade dysplasia was detected (N = 96, 1%). From 1997 to 1998, two cancers and three high-grade dysplasias were detected during rigorous surveillance (N = 108, 4.6%). Three of these patients have had curative esophagectomies (one high-grade dysplasia and two T1,N0,M0 tumors). In 1992-1997, 10 patients were found to have cancer in previously undiagnosed Barrett's esophagus (N = 262, 3.8%). Of 3/10 cancers treated surgically, one patient had a curative procedure (T1,N0,M0). In 1997-1998, nine patients were found to have de novo Barrett's esophagus cancer (N = 88, 10.2%) and three had curative resections (T1,N0,M0). Two of the patients with T1 lesions had no endoscopic evidence of cancer but were detected as a result of the multiple biopsy protocol. In conclusion, a rigorous biopsy protocol increases the detection of early cancer in Barrett's esophagus.
UI - 21448541
AU - Wolf RL; Zybert P; Brouse CH; Neugut AI; Shea S; Gibson G; Lantigua RA;
TI - Basch CE Knowledge, beliefs, and barriers relevant to colorectal cancer screening in an urban population: a pilot study.
SO - Fam Community Health 2001 Oct;24(3):34-47
AD - Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York, USA.
A sample of 115 urban, working-class, predominantly minority men and women was interviewed by telephone to assess knowledge, beliefs, and barriers relevant to colorectal cancer (CRC) and CRC screening. More than half (53.9%) were unable to name a CRC screening test. Misconceptions were common. Dispelling inaccurate beliefs, establishing an individual's preference for fecal occult blood tests or flexible sigmoidoscopy, and helping individuals take a proactive role in the receipt of CRC screening are important goals for health education efforts aimed at increasing rates of CRC screening. Participants' willingness to engage in detailed telephone conversations about CRC and CRC screening was encouraging.
UI - 21439162
AU - Mahavni V; Sood AK
TI - Hormone replacement therapy and cancer risk.
SO - Curr Opin Oncol 2001 Sep;13(5):384-9
AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
The advantages and disadvantages of hormone replacement therapy (HRT) have been debated nearly as long as the treatment has been in use, especially the relationship between HRT and risk of cancer development. It is hoped that recently published studies will shed more light on this complex issue. Several large population studies suggest that there may be a small but increased risk of developing breast cancer in HRT users, especially in estrogen and progesterone users. This risk appears most pronounced after 5 years of HRT use. Endometrial cancer, which has long been associated with unopposed estrogen use, can be successfully prevented with the addition of progestins to the HRT regimen, provided it is given for at least 10 days each month. Estrogen replacement therapy has also been shown to significantly reduce the risk for colon cancer but not rectal cancers. Finally, a large prospective study has linked HRT with an increase in ovarian cancer mortality.
UI - 21452080
AU - Rakowski V; DeDecker L; Westendorp J
TI - Knowing is most of the battle.
SO - Mich Health Hosp 2001 Sep-Oct;37(5):38
AD - Cancer Control, American Cancer Society, Great Lakes Division, Lansing, USA.
Colorectal carcinoma is the fourth most frequently diagnosed cancer and second most frequent cause of death from cancer in the United States. Each year in Michigan, more than 5,000 people are diagnosed with invasive colorectal cancer, and more than 2,000 persons die from this disease.
UI - 21462454
AU - Morris CD; Byrne JP; Armstrong GR; Attwood SE
TI - Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation.
SO - Br J Surg 2001 Oct;88(10):1357-62
AD - Department of Upper Gastrointestinal Surgery, Hope Hospital, Stott Lane, Salford, Manchester M6 8HD, UK.
BACKGROUND: Patients with Barrett's oesophagus have a risk of approximately 1 per 100 patient-years for the development of oesophageal adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been shown to lead to the regrowth of a 'neo' squamous epithelium if gastro-oesophageal reflux is controlled, but the incidence of subsequent tumour formation is unknown. METHODS: The follow-up of 55 patients who underwent endoscopic ablation of Barrett's oesophagus by argon beam plasma coagulation (ABPC) is reported. Of the 55 patients, nine had low-grade dysplasia, nine had high-grade dysplasia and the remainder had non-dysplastic Barrett's metaplasia. Twelve patients had reflux control by antireflux surgery and the remainder received proton pump inhibitor therapy. Barrett's metaplasia was ablated by ABPC to within 2 cm of the gastro-oesophageal junction. RESULTS: To date, one patient has died and one patient was unable to complete treatment. The remaining patients were followed by regular endoscopic surveillance for a mean of 38.5 months to give a total follow-up of 173.5 patient-years. No malignancy has developed in any patient during follow-up. CONCLUSION: The absence of malignant complications in this study of prophylactic ablation of long-segment Barrett's oesophagus strengthens the argument for endoscopic ablation in the prevention of oesophageal adenocarcinoma.
UI - 21481726
AU - Standard Task Force; American Society of Colon and Rectal Surgeons;
TI - Collaborative Group of the Americas on Inherited Colorectal Cancer Practice parameters for the identification and testing of patients at risk for dominantly inherited colorectal cancer.
SO - Dis Colon Rectum 2001 Oct;44(10):1403
UI - 21481727
AU - Church J; Lowry A; Simmang C; The Standards Task Force; American Society
TI - of Colon and Rectal Surgeons Practice parameters for the identification and testing of patients at risk for dominantly inherited colorectal cancer--supporting documentation.
SO - Dis Colon Rectum 2001 Oct;44(10):1404-12
UI - 21128990
AU - Ziebert JJ
TI - Colorectal cancer screening: the old and the new.
SO - Tex Med 2001 Feb;97(2):46-8
As the second leading cancer killer of Americans, colorectal cancer represents a serious health threat to all Americans. All health care providers and patients should demand colorectal cancer screening, which has been shown to decrease the incidence and mortality of the disease through the detection and removal of the cancer's precursor lesion, the adenomatous polyp. Colonoscopy is the most effective screening tool because it identifies and treats more polyps than any other screening tool available today. However, cost issues have led to considerable controversy regarding its universal application as a screening tool.
UI - 96025018
AU - Smith KR; Croyle RT
TI - Attitudes toward genetic testing for colon cancer risk.
SO - Am J Public Health 1995 Oct;85(10):1435-8
AD - Genetic Science in Society Program, University of Utah, Salt Lake City 84112, USA.
This study examined public interest regarding genetic testing for colon cancer susceptibility. Survey data were collected from 383 adults in Utah. Respondents were very (47.3%) or somewhat (36.6%) interested in taking this genetic test. Nearly 95% reported that they would share their results with others. Individuals with higher income and with a perceived risk of getting colon cancer were the most interested in testing. Individuals without health insurance and widowed individuals were the least likely to share their test results. If respondents were told that they carried a gene for colon cancer, most would be concerned with how to reduce their risk of getting the disease.
UI - 21325274
AU - Ore L; Hagoel L; Lavi I; Rennert G
TI - Screening with faecal occult blood test (FOBT) for colorectal cancer: assessment of two methods that attempt to improve compliance.
SO - Eur J Cancer Prev 2001 Jun;10(3):251-6
AD - Department of Community Medicine and Epidemiology, Carmel Medical Center and The Faculty of Medicine, Technion, Haifa, Israel.
Screening with the faecal occult blood test (FOBT) has been shown in randomized control trials to be effective in reducing mortality from colorectal cancer. Compliance to this test recommendation, however, by the general population is usually low. To evaluate different methods of increasing compliance with FOBT, using mailed test kits or order cards, with or without information leaflets, subjects were randomly assigned to receive a test kit or a kit request card. An information leaflet was included in half of the mailings. All participants were contacted for interview. Compliance was evaluated through the central computer system of the study's FOBT laboratory. Self-initiated compliance with FOBT in the year preceding the study was 0.6% of the study participants. The overall compliance rate with the programme invitation was 17.9%, with a somewhat higher, though non-significant response to the mailed kit (19.9%) over the kit request card (15.9%). Women complied with the test significantly more than men, older participants more than younger. Compliance to FOBT is low among the Israeli population aged 50-74 who receive a formal invitation to carry out this screening. Mailing a kit request card within the framework of a screening programme can achieve a substantial increase (to 17.9%) in the level of compliance for the relatively low cost of postage. More effort is needed to study additional means of convincing the non-responders to take part in this potentially life saving activity.
UI - 21325275
AU - You WC; Chang YS; Heinrich J; Ma JL; Liu WD; Zhang L; Brown LM; Yang CS;
TI - Gail MH; Fraumeni JF Jr; Xu GW An intervention trial to inhibit the progression of precancerous gastric lesions: compliance, serum micronutrients and S-allyl cysteine levels, and toxicity.
SO - Eur J Cancer Prev 2001 Jun;10(3):257-63
AD - National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892, USA. firstname.lastname@example.org
Gastric cancer is the second most frequent cause of death from cancer in the world and the leading cause of death from cancer in China. In inhibit the progression of precancerous gastric lesions in Linqu County, Shandong Province, an area of China with one of the world's highest rates of gastric cancer. Treatment compliance was measured by pill counts and quarterly serum concentrations of vitamin C, vitamin E and S-allyl cysteine. In 1999, toxicity information was collected from each trial participant to evaluate treatment-related side-effects during the trial. Compliance rates were 93% and 92.9% for 39 months of treatment with the vitamins/mineral and garlic preparation, respectively. The means for serum concentrations of vitamins C and E were 7.2 microg/ml and 1695 microg/dl among subjects in the active treatment groups compared with 3.1 microg/ml and 752 microg/dl among subjects in the placebo treatment group, respectively. No significant differences in side-effects were observed between the placebo treatment group and the vitamins/mineral and garlic preparation treatment groups during the 39-month trial period.
UI - 21455731
AU - Myers RE; Turner B; Weinberg D; Hauck WW; Hyslop T; Brigham T; Rothermel
TI - T; Grana J; Schlackman N Complete diagnostic evaluation in colorectal cancer screening: research design and baseline findings.
SO - Prev Med 2001 Oct;33(4):249-60
AD - Division of Medical Oncology and Medical Genetics, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
BACKGROUND: While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X ray), is often not recommended and performed for persons with an abnormal screening fecal occult blood test (FOBT) result. We initiated a randomized trial to assess the impact of a physician-oriented intervention on CDE rates in primary care practices. METHODS: In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a managed care organization screening program. A total of 470 PCPs in 318 practices completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Group practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-feedback plus educational outreach). Practice CDE recommendation and performance rates are the primary outcomes to be measured in the study. RESULTS: Baseline CDE recommendation and performance rates were low and were comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians were more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine. CONCLUSIONS: We were able to enroll a high proportion of targeted primary care practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will take into account baseline differences in practice characteristics. Copyright 2001 American Health Foundation and Academic Press.
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