Colorectal cancer screening and surveillance practices by primary care physicians: Results of a national survey

OBJECTIVE: Screening for colorectal cancer reduces its morbidity and mortal ity and is cost-effective. Screening is usually the responsibility of prima ry care physicians who may be unsure about its implementation. We aimed to assess primary care physicians' knowledge and practice regarding colorectal cancer screening, and to compare their responses with those of three natio nal experts and with published guidelines. METHODS: We mailed a postal questionnaire to 2310 primary care physicians r egarding demographics, nature of practice, use of screening tests, and six hypothetical patients who may have been candidates for screening or surveil lance. We used published national guidelines and the collective opinions of the three external experts as the so-called "gold standard." RESULTS: Of all respondents, 85.1% offered colorectal cancer screening. Mos t used suitable tests, starting at an appropriate age; 49.8% continued scre ening indefinitely irrespective of patients' age and 43.6% performed fecal occult blood testing without appropriate dietary advice to patients. Also, respondents frequently performed this test for inappropriate indications. O nly 51.8% would follow a positive fecal occult blood test with colonoscopy. CONCLUSIONS: Colorectal cancer screening practices by primary care physicia ns vary considerably from those recommended. Many offer screening to indivi duals in whom it is not appropriate, and continue it into advanced age. Fre quent, inappropriate use of fecal occult blood tests will produce many fals e positives. Primary care physicians often do not appropriately follow a po sitive test. Further educational efforts are needed in an attempt to improv e practice and further reduce the morbidity and mortality from colorectal c ancer. (Am J Gastroenterol 2000;95:1551-1556. (C) 2000 by Am. Cell. of Gast roenterology).