Afridi S A, Jafri S F, Marshall J B
Division of Gastroenterology, University of Missouri School of Medicine, Columbia.
Am J Gastroenterol. 1994 Dec;89(12):2184-7.
Colorectal cancer is a leading cause of mortality from cancer in the United States. Unfortunately, many patients already have advanced disease by the time symptoms occur. Screening of asymptomatic persons offers the potential of detecting the disease at its early and curable stages. The American Cancer Society (ACS) screening recommendations are the most widely employed in this country. We sought to determine whether gastroenterologists themselves follow the ACS recommendations, and if not, to determine their reasons for not doing so. We also looked at gastroenterologists' use of diets and supplements that might reduce the likelihood of colorectal cancer.
A questionnaire was mailed out to all gastroenterologists with U.S. addresses listed in the American College of Gastroenterology membership directory.
Of 1466 respondents, 330 were excluded because they were at high risk for colorectal cancer or were not gastroenterologists. This left 875 gastroenterologists age 40 years and over and 261 gastroenterologists under age 40 for analysis. Overall, 68% of respondents felt the ACS recommendations were adequate; 32% did not. Of those who disagreed with the ACS recommendations, 58% preferred screening colonoscopy, and 22% preferred flexible sigmoidoscopy without annual fecal occult blood testing. Of gastroenterologists age 40 and over, 38% strictly followed the ACS recommendations themselves, 39% partially, and 23% did not follow them. Fifty percent of those who did not strictly follow the recommendations believed they were adequate but procrastinated or "did not have the time" to follow them. Overall, 82% of gastroenterologists said they used a high fiber diet, 68% used a diet low in fat, 18% used a calcium supplement, and 25% used aspirin regularly.
Although two-thirds of gastroenterologists agreed with the ACS recommendations, only 38% themselves followed them strictly. Of the approximately one-third of gastroenterologists who considered them inadequate, a majority preferred screening colonoscopy. Gastroenterologists were more aggressive in following dietary practices that might help prevent colorectal cancer development than they were in undergoing screening.
在美国，结直肠癌是癌症致死的主要原因之一。不幸的是，许多患者在出现症状时就已经患有晚期疾病。对无症状人群进行筛查有可能在疾病的早期可治愈阶段检测出该病。美国癌症协会（ACS）的筛查建议是美国使用最广泛的。我们试图确定胃肠病学家自己是否遵循ACS的建议，如果不遵循，找出他们不这样做的原因。我们还研究了胃肠病学家对可能降低结直肠癌发生可能性的饮食和补充剂的使用情况。
向美国胃肠病学会会员名录中列出的所有在美国有地址的胃肠病学家邮寄了一份问卷。
在1466名受访者中，330人因患结直肠癌风险高或不是胃肠病学家而被排除。剩下875名40岁及以上的胃肠病学家和261名40岁以下的胃肠病学家进行分析。总体而言，68%的受访者认为ACS的建议足够；32%的人不这样认为。在那些不同意ACS建议的人中，58%更喜欢筛查结肠镜检查，22%更喜欢灵活乙状结肠镜检查而不进行年度粪便潜血检测。在40岁及以上的胃肠病学家中，38%自己严格遵循ACS的建议，39%部分遵循，23%不遵循。在那些没有严格遵循建议的人中，50%认为建议足够，但拖延或“没有时间”遵循。总体而言，82%的胃肠病学家表示他们采用高纤维饮食，68%采用低脂肪饮食，18%使用钙补充剂，25%经常使用阿司匹林。
虽然三分之二的胃肠病学家同意ACS的建议，但只有38%自己严格遵循。在大约三分之一认为这些建议不足的胃肠病学家中，大多数更喜欢筛查结肠镜检查。胃肠病学家在遵循可能有助于预防结直肠癌发展的饮食习惯方面比进行筛查更积极。
