Australian general practitioners' views and use of colorectal cancer screening tests

Objectives: To determine general practitioners' (GPs) current beliefs, know ledge and self-reported practices of screening for colorectal cancer. Design and settings: Postal survey of national random sample of 1271 GPs in 1996. Outcome measures: GP views on effectiveness of faecal occult blood testing (FOBT) and flexible sigmoidoscopy in reducing premature death from colorect al cancer in "average-risk" patients (asymptomatic with no family history); views on frequency of tests and target group; use of these tests; and inde pendent predictors of views and use. Results: Response rate was 67%. FOBT and flexible sigmoidoscopy were said t o be effective as screening tests by 38% and 61% of GPs, respectively, but 30% and 25% were unsure. Independent predictors of belief in screening effe ctiveness were Stale of practice (for FOBT), male sex and awareness of Gut Foundation guidelines (for flexible sigmaidoscopy) and increasing age (far bath). Most often chosen screening frequencies were every year for FOBT (29 %), and five-yearly for flexible sigmoidoscopy (24%), although 19% and 26%, respectively, were unsure of the appropriate screening interval. Most ofte n cited target group was people aged over 40 years with first-degree relati ves with colorectal cancer: 63% of GPs would offer FOBT and 74%, flexible s igmoidoscopy. Fewer than 3% of GPs were likely to adopt an opportunistic ap proach to screening, yet 15% would be highly likely to recommend FOBT durin g a dedicated health check-up for a 58-year-old male patient, and 9% for a female patient. Conclusion: The absence to date of a coherent national policy on colorectal cancer screening is associated with wide variations in views and practice that are inconsistent with the available evidence. If GPs are to be involve d in implementing population screening, national policy must be widely and effectively promulgated.