Colorectal carcinoma screening attitudes and practices among primary care physicians in counties at extremes of either high or low cancer case-fatality

BACKGROUND, To the authors' knowledge, physician attitudes and reported pra ctices regarding colorectal carcinoma screening have not been studied in ar eas of highest risk for cancer death. METHODS, Medicare claims were used to calculate colorectal carcinoma 2-year case-fatality rates for counties with > 100 incident cases of colorectal c arcinoma between 1991-1993, All 2682 practicing primary care physicians in 20 counties with the lowest case-fatality rates (mean of 29.9%) and 19 coun ties with the highest case-fatality rates (mean of 47.8%) were surveyed reg arding their screening procedures and attitudes. RESULTS. Among the 972 respondents (36.1%), the reported use of fecal occul t blood testing (FOBT) and flexible sigmoidoscopy was similar in the low an d high case-fatality counties. However, physicians who practiced in the hig h case-fatality counties were less likely to be trained in and to perform s igmoidoscopy themselves (37.0% vs. 45.6%; P < 0.01). Moreover, practitioner s in the high case-fatality counties were more likely than the other physic ians to consider or plan enhanced FOBT and sigmoidoscopic screening in the near future. FOBT and sigmoidoscopy screening rates at the county level wer e associated negatively with cancer incidence rates, case-fatality rates, a nd metastatic disease rates, suggesting a potentially protective effect. CONCLUSIONS, Geographically targeted interventions are a potentially cost-e ffective strategy for focusing additional screening services on the highest risk populations. The primary care clinicians in these high risk areas are logical partners for these interventions by virtue of their high degree of readiness to change their current screening practices. (C) 1999 American C ancer Society.