Fewer than one in five U.S. primary-care physicians follow practice guidelines for all recommended colorectal cancer (CRC) screening modalities.
After examining survey data from 1,266 physicians nationwide, K. Robin Yabroff, PhD, MBA, and fellow researchers learned that only 19.1% made guideline-consistent recommendations across the menu of CRC screening tests. A larger proportion (40%) made at least some recommendations that were guideline-consistent. However, 41% made CRC screening recommendations for which none were guideline-consistent.
Most of the surveyed practitioners appropriately recommended initial screening and screening intervals for individual tests in average-risk patients at age 50 years, but only one in five made guideline-consistent recommendations for both screening initiation and screening intervals across all tests they recommended. As noted in the online report in Journal of General Internal Medicine, some physicians recommended initiating screening in patients older than age 50 years or at longer intervals than specified in guidelines.
The most guideline-consistent providers tended to be younger, board-certified, users of electronic medical records and influenced by published clinical evidence.
Investigators also identified changes in screening-related practice patterns: Many more providers recommended colonoscopy in 2007 than in 2000 (95% vs. 37%), and far fewer recommended sigmoidoscopy (26% vs. 76%). In 2007, colonoscopy and fecal occult blood testing was the most common combination of screening tests recommended.
In another online report — this one from the journal Cancer — Moshe Shike, MD, and colleagues described another aspect of CRC screening: expanding the testing to minority patients. To increase CRC screening rates among women in a primarily African-American and Hispanic community, Dr. Shike’s team used a community-outreach mammography program to explain screening and perform colonoscopies. Of 2,616 eligible women, 611 (23%) enrolled; the remainder refused to participate. More than half of the enrollees (337) went on to have a screening colonoscopy; 49 (15%) were found to have adenomatous polyps.
Offering CRC screening to women at the time of mammography and without a physician’s referral was found to be an effective way to expand testing.