PREFERENCES OF COMMUNITY PHYSICIANS FOR CANCER SCREENING GUIDELINES

Objective: To assess factors related to consensus among community phys icians regarding appropriate screening intervals for eight cancer scre ening procedures for which guidelines have been published. Design: Int erviews were conducted with a national random sample of 3436 physician s in family practice, internal medicine, general surgery, and gynecolo gy by mail or telephone or both. The overall response rate was 67%. Me asurements: Consensus by specialization and by physician and practice characteristics on the appropriate screening intervals for early detec tion of cancers of the breast, cervix, colon and rectum, and lung for asymptomatic adults at normal risk. ii Results: More than 60% of the p hysicians surveyed agreed on the length of the screening intervals for six of eight procedures. Consensus most closely followed American Can cer Society- and National Cancer Institute-recommended screening inter vals for all procedures except chest roentgenogram Acceptance of scree ning intervals was not related to the extent of agreement among publis hed guidelines. Surgeons tended to favor more aggressive screening tha n family physicians and internists; gynecologists most consistently fa vored aggressive screening for cancers occurring in women. Older physi cians and those in solo practice tended to favor outmoded procedures s uch as routine chest roentgenograms and to be more conservative about screening intervals. Conclusions: Physicians stated that they follow t he American Cancer Society and National Cancer Institute guidelines fo r cancer screening more than the guidelines published by their own spe cialty societies, but they also reported procedures not recommended in any guidelines. These findings suggest that changing physician screen ing practices will be difficult.