Reported cancer screening practices of nephrologists: results from a national survey

Abstract

Cancer is becoming increasingly recognized as a complication of chronic kidney disease (CKD), and screening is a widely used strategy to reduce cancer risk and improve outcomes. This study aimed to describe cancer screening practices by nephrologists in Australia and New Zealand, and to identify reasons for a positive recommendation to screen. Questionnaires were posted electronically to all nephrologists who were in adult clinical practice in 2007 using the Australia-New Zealand Society of Nephrology register. The survey instrument assessed nephrologists' reported practice towards colorectal, breast and cervical cancer screening across all stages of CKD (CKD 1-5, dialysis and transplantation). Of the 250 eligible members, 131 (52%) participated, with over 75% recommending breast cancer screening (usually 1-2 yearly using combined mammography and breast-self examination), 48% recommending colorectal cancer screening (1-2 yearly faecal occult blood test) and 86% recommending cervical cancer screening (1-2 yearly conventional cytology). Recommendations to screen did not vary appreciably with CKD status. Recommended screening strategies were more frequent, included more invasive tests, and were targeted at a broader age range than national cancer screening programmes in the general population. Increased cancer prevalence and cancer-specific mortality benefits for screening were the most commonly reported and influential criteria for making a positive recommendation. Most nephrologists recommend breast and cervical, but not colorectal cancer screening in people with CKD. Despite the lack of trial-based evidence of benefits of screening in this setting, recommended screening practices by nephrologists are more intense than for the general population. Increased disease prevalence appears to be the most influential factor for making a positive recommendation to screen in the CKD population even though this is not an internationally accepted criterion for a screening programme, and is not relevant for breast cancer, which is not increased in the CKD population.