Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States.

BACKGROUND

Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screening tests save lives. Nevertheless, these 2 statistics are often used to promote screening.

OBJECTIVE

To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives.

DESIGN

Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials.gov registration number: NCT00981019)

SETTING

National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate).

PARTICIPANTS

297 physicians who practiced both inpatient and outpatient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011.

INTERVENTION

Physicians received scenarios about the effect of 2 hypothetical screening tests: The effect was described as improved 5-year survival and increased early detection in one scenario and as decreased cancer mortality and increased incidence in the other.

MEASUREMENTS

Physicians' recommendation of screening and perception of its benefit in the scenarios and general knowledge of screening statistics.

RESULTS

Primary care physicians were more enthusiastic about the screening test supported by irrelevant evidence (5-year survival increased from 68% to 99%) than about the test supported by relevant evidence (cancer mortality reduced from 2 to 1.6 in 1000 persons). When presented with irrelevant evidence, 69% of physicians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowledge questions about screening statistics, many physicians did not distinguish between irrelevant and relevant screening evidence; 76% versus 81%, respectively, stated that each of these statistics proves that screening saves lives (P = 0.39). About one half (47%) of the physicians incorrectly said that finding more cases of cancer in screened as opposed to unscreened populations "proves that screening saves lives."

LIMITATION

Physicians' recommendations for screening were based on hypothetical scenarios, not actual practice.

CONCLUSION

Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evidence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening.

PRIMARY FUNDING SOURCE

Harding Center for Risk Literacy, Max Planck Institute for Human Development.