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Many primary physicians' colorectal cancer screening practices inadequate
WESTPORT, Jun 20 (Reuters Health) - Screening practices for colorectal cancer among primary care physicians "vary widely" from recommended guidelines, according to a report in this month's issue of The American Journal of Gastroenterology.
Dr. Virender K. Sharma from the University of Arkansas for Medical Sciences, in Little Rock, and a multicenter group mailed a questionnaire to 2,310 primary care physicians, mostly family physicians and internists, throughout the US. Among other items, the questionnaire asked whether physicians would offer colorectal cancer screening to six hypothetical patients.
The researchers received responses from 417 physicians, or 19.5%. According to the report, 85.1% of the respondents offered colorectal cancer screening routinely. The researchers say that most physicians used suitable tests that were begun at the appropriate age.
However, 49.8% of the physicians "continued screening indefinitely irrespective of patients' age and 43.6% performed fecal occult blood testing without appropriate dietary advice to patients," Dr. Sharma's group found. Furthermore, fecal occult blood testing was frequently performed for "inappropriate indications," and the researchers report that "only 51.8% would follow a positive fecal occult blood test with colonoscopy."
Dr. Sharma's group believes that immediate remediation is needed to teach primary care physicians about colorectal cancer screening, including how to identify appropriate candidates. They add that "it is futile--and arguably immoral--to fail to act on results of a screening test that [has] been properly applied."
In a related editorial, Dr. Sarah Tropman Hawley from Baylor College of Medicine, and Dr. Bernard Levin from the University of Texas M. D. Anderson Cancer Center, both in Houston, Texas, agree with the findings of the study but add, "Missing from the discussion is the issue of potential barriers or facilitators to the recommendations and follow-up of colorectal cancer screening by primary care physicians."
The barriers mentioned by Drs. Hawley and Levin include uncertainty about the efficiency of screening and uncertainty about patient compliance. The editorialists also point out that reimbursement for screening costs, equipment availability and required referral patterns are healthcare-system factors that "may also impede or facilitate colorectal cancer screening practice patterns in primary care environments." |
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