Colorectal Cancer Screening and Surveillance Practices by Primary Care Physicians: Results of a National Survey

Reviewers: Li Liu, MD
Source: The American Journal of Gastroenterology, Volume 95:1551-1556, (June) 2000.

Précis: Colorectal cancer screening by many primary physicians may not be adequate

Introduction

The American Cancer Society and the American Gastroenterological Association, as well as other groups, have all recommended screening for colorectal cancer. Standard recommendations include annual testing for fecal occult blood and periodic sigmoidoscopy/colonoscopy after the age of 50 years for persons at average risk for colorectal cancer. However, how well these recommendations have been carried out in the community by primary care physicians is unclear.

Method

In this study, the researchers mailed a questionnaire to 2,310 primary care physicians throughout the US. Among other items, the questionnaire asked whether physicians would offer colorectal cancer screening to 6 hypothetical patients.

Results

A total of 417 physicians (19.5%) responded.

• 85.1% of the respondents offered some form of colorectal cancer screening routinely.
• About half of the physicians never stopped screening irrespective of patient?s age.
• 43.6% of the physicians did not offer appropriate dietary advice to patients in preparation for fecal occult blood test (3 day avoidance of rare meat and some vegetables such as broccoli, turnips, and radishes).
• About half of the physicians did not follow a positive fecal occult blood test with colonoscopy.

Discussion

In this study, screening practices for colorectal cancer among primary care physicians varied widely from recommended guidelines. Aversion to the nature of the problem, the procedures used for screening, screening costs, and required referral patterns have presented major barriers to compliance with the recommendations. Immediate remediation is needed to teach primary care physicians about colorectal cancer screening, including how to identify appropriate candidates.