Sharma V K, Vasudeva R, Howden C W
University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205-7199, USA.
Am J Gastroenterol. 2000 Jun;95(6):1551-6. doi: 10.1111/j.1572-0241.2000.02093.x.
Screening for colorectal cancer reduces its morbidity and mortality and is cost-effective. Screening is usually the responsibility of primary 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 national experts and with published guidelines.
We mailed a postal questionnaire to 2,310 primary care physicians regarding demographics, nature of practice, use of screening tests, and six hypothetical patients who may have been candidates for screening or surveillance. We used published national guidelines and the collective opinions of the three external experts as the so-called "gold standard."
Of all respondents, 85.1% offered colorectal cancer screening. Most used suitable tests, starting at an appropriate age; 49.8% continued screening 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. Only 51.8% would follow a positive fecal occult blood test with colonoscopy.
Colorectal cancer screening practices by primary care physicians vary considerably from those recommended. Many offer screening to individuals in whom it is not appropriate, and continue it into advanced age. Frequent, inappropriate use of fecal occult blood tests will produce many false positives. Primary care physicians often do not appropriately follow a positive test. Further educational efforts are needed in an attempt to improve practice and further reduce the morbidity and mortality from colorectal cancer.
筛查结直肠癌可降低其发病率和死亡率，且具有成本效益。筛查通常由初级保健医生负责，他们可能不确定如何实施。我们旨在评估初级保健医生关于结直肠癌筛查的知识和实践，并将他们的回答与三位国家专家的回答以及已发表的指南进行比较。
我们向2310名初级保健医生邮寄了一份邮政问卷，内容涉及人口统计学、执业性质、筛查测试的使用，以及六名可能是筛查或监测对象的假设患者。我们将已发表的国家指南和三位外部专家的集体意见用作所谓的“金标准”。
在所有受访者中，85.1%提供结直肠癌筛查。大多数人使用合适的测试，从适当的年龄开始；49.8%无论患者年龄如何都无限期地继续筛查，43.6%在未向患者提供适当饮食建议的情况下进行粪便潜血测试。此外，受访者经常对不适当的指征进行这项测试。只有51.8%的人会在粪便潜血测试呈阳性后进行结肠镜检查。
初级保健医生的结直肠癌筛查实践与推荐的做法有很大差异。许多人对不适合的个体进行筛查，并持续到高龄。频繁、不恰当地使用粪便潜血测试会产生许多假阳性结果。初级保健医生往往没有对阳性测试结果进行适当的后续处理。需要进一步开展教育工作，以改进实践并进一步降低结直肠癌的发病率和死亡率。
