Abstract
BackgroundData comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Since adjustment for stage at diagnosis markedly reduces the survival differences, a screening bias was hypothesized. Considering the important role of primary care in screening activities, the purpose of the study was to investigate the colorectal cancer screening awareness among Hellenic physicians.Methods211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed.ResultsOnly 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012). No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054).ConclusionContemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality.
Highlights
Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries
We found that the 50% (106/211) of physicians recommended colorectal cancer screening during usual check
When physicians were asked about which examinations they think should be prescribed to people older than 50 for cancer screening practice, only the 77% recognized a value for colorectal cancer screening tests
Summary
Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Deficiencies in European colorectal cancer screening guideline implementation, and inadequacy of screening test advising in primary care setting were highlighted in a recent systematic review of literature, but only data from Italian and French physicians were available for the USA vs European data comparison [3]. Colorectal cancer screening survival benefit had been strongly documented by randomized-controlled trials [48] and a meta-analysis [9] In this setting, time to diagnosis and, more precisely, stage at surgery, play the major role for patient outcome. Physicians involved in primary care both implement programs with active invitation [17] and recommend screening tests where invitation programs are lacking This is of particular importance in Greece where organized colorectal cancer screening programs are totally absent
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