Above-average Risk Research Articles

Long-term Cardiovascular Mortality Among Middle-aged Men With Gout

There are limited data available on the association of gouty arthritis (gout) in middle age with long-term cardiovascular disease (CVD) mortality. We performed a 17-year follow-up study of 9105 men, aged 41 to 63 years and at above-average risk for coronary heart disease, who were randomized to the Multiple Risk Factor Intervention Trial and who did not die or have clinical or electrocardiographic evidence of coronary artery disease during the 6-year trial. Risk of CVD death and other causes subsequent to the sixth annual examination associated with gout was assessed by means of Cox proportional hazards regressions. The unadjusted mortality rates from CVD among those with and without gout were 10.3 per 1000 person-years and 8.0 per 1000 person-years, respectively, representing an approximately 30% greater risk. After adjustment for traditional risk factors, use of diuretics and aspirin, and serum creatinine level, the hazard ratio (gout vs no gout) for coronary heart disease mortality was 1.35 (95% confidence interval [CI], 1.06-1.72). The hazard ratio for death from myocardial infarction was 1.35 (95% CI, 0.94-1.93); for death from CVD overall, 1.21 (95% CI, 0.99-1.49); and for death from any cause, 1.09 (95% CI, 1.00-1.19) (P = .04). The association between hyperuricemia and CVD was weak and did not persist when analysis was limited to men with hyperuricemia without a diagnosis of gout. Among middle-aged men, a diagnosis of gout accompanied by an elevated uric acid level imparts significant independent CVD mortality risk. clinicaltrials.gov Identifier: NCT00000487.

Colorectal cancer screening perceptions and practices: Results from a national survey of gastroenterology, surgery and radiology trainees

Colorectal cancer (CRC) screening in the United States is suboptimal. We conducted a national survey to learn about CRC screening perceptions and practices among trainees who perform CRC screening tests including those enrolled in Gastroenterology and Hepatology (GIH), General and Colorectal Surgery, and Diagnostic and Abdominal Radiology training programs. Program directors/administrators (PDs/PAs) from 642 programs were contacted by e-mail with an invitation to forward our survey to trainees in their programs. Participating trainees then completed an anonymous, Web-based questionnaire. A total of 130/642 (20%) PDs/PAs forwarded our survey to their trainees, with responses received from 476 trainees (80 GIH, 261 surgery, 135 radiology). Colonoscopy was felt to be the best CRC screening test at reducing CRC mortality, with patient-related factors perceived as greater barriers than system-related factors. No single guideline was deemed very influential on CRC screening practices by most trainees. A total of 2 of 5 above-average risk patient profiles were not recognized by most trainees. Colonoscopy was selected as the preferred follow-up test for a positive CRC screening test by most trainees. However, 34% of respondents chose an option other than colonoscopy alone for follow-up of a positive fecal occult blood test. Based on data from this national survey of gastroenterology, surgery, and radiology trainees, opportunities exist for curricular changes that may help enhance current perceptions and practices of trainees who perform CRC screening tests.

Analyzing BSE Transmission to Quantify Regional Risk

As a result of consumer fears and political concerns related to BSE as a risk to human health, a need has arisen recently for more sensitive methods to detect BSE and more accurate methods to determine BSE incidence. As a part of the development of such methods, it is important to be able to identify groups of animals with above-average BSE risk. One of the well-known risk factors for BSE is age, as very young animals do not develop the disease, and very old animals are less likely to develop the disease. Here, we analyze which factors have a strong influence on the age distribution of BSE in a population. Building on that, we develop a simple set of calculation rules for classifying the BSE risk in a given cattle population. Required inputs are data on imports and on the BSE control measures in place over the last 10 or 20 years.

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks

Objective Cost-effectiveness analyses are routinely based on data from group averages, restricting its generalizibility to those with below- or above-average risk. A pharmaco-economic model that used individualized risks for fractures was developed in order to take into account patient heterogeneity. Methods Data were obtained from The Health Improvement Network research database of general practitioners, comprising a UK general population of women aged more than 50 years (N = 330,000). Mortality and hip, vertebral, and other osteoporotic fracture risks for each individual were estimated by age, body mass index (BMI), smoking, and other clinical risk factors. Estimates on costs, EuroQol (EQ-5D) utilities, and treatment efficacy were obtained from a UK national report (the National Institute for Clinical Excellence) and outcomes were simulated over a 10-year period. Results It was found that the cost per quality-adjusted life-year (QALY) gained was lower in elderly women and inwomen with fracture history. There was a large variability in the cost-effectiveness with baseline fracture risk and with clinical risk factors. Patients with low BMI (<20) had considerable better cost-effectiveness than patients with high BMI (≥26). Using a cost-acceptability ratio of £30k per QALY gained, bisphosphonate treatment became cost-effective for patients with a 5-year risk of 9.3% (95% confidence interval [CI] 8.0–10.5%) for osteoporotic fractures and of 2.1% (95% CI 1.5–2.7%) for hip fractures. Including bone mineral density in the risk assessment, the cost per QALY gained was £35k in women at age 60 with a fracture history and a T-score of −2.5 (at age 80, this was £3k). Conclusion A pharmacoeconomic model based on individual long-term risks of fracture improves the selection of postmenopausal women for cost-effective treatment with bisphosphonates.

Workplace Colorectal Cancer–Screening Awareness Programs: An Adjunct to Primary Care Practice?

Although regular screening can decrease morbidity and mortality from colorectal cancer, screening rates nationwide are suboptimal due to a lack of organized screening programs. Since workplace colorectal cancer-awareness programs can potentially mitigate both patient and physician barriers to screening, we assessed the workplace as a venue for implementing a colorectal cancer screening-awareness program. In this cross-sectional study, 3756 members of the Toronto Police Service attended an education session about colorectal cancer; 965 of these members gave their informed consent and completed a 5-item colorectal cancer risk-assessment questionnaire. Nearly one-third (30.9%, or 298/965) of this relatively young population (83.1%, or 802/965, < 50 years of age) were at average or above-average risk for colorectal cancer. In the Toronto Police Service population, the workplace was a useful adjunct to reliance on primary care physicians to raise awareness about this important public health issue. These findings should encourage the development of further Canadian workplace colorectal cancer-screening awareness programs.

Family History, Perceived Risk, and Prostate Cancer Screening among African American Men

Many African American men have two major risk factors for prostate cancer. By ethnicity alone, they have twice the risk of Euro-American men of developing prostate cancer. Having a family history (brother or father with prostate cancer) also doubles their risk. The major hypotheses tested in this study are that men with a family history perceive their risk to be higher, are more worried about getting prostate cancer, and are more likely to have used cancer screening tests than men without such a history. A sample of 208 African American men, ages 40 to 74 years, were recruited through relatives or friends whose prostate cancer diagnosis was reported to the California Cancer Registry during the years 1997 to 2001 and from churches and African American social groups. Following a screening interview to determine eligibility, 88 men with self-reported, first-degree family history of prostate cancer and 120 without such history were interviewed by telephone. Logistic regression was used to create models of perceived risk, prostate cancer worries, receipt of a digital rectal exam, and/or prostate-specific antigen (PSA) testing. Men with a self-reported family history of prostate cancer did not perceive their risk as higher than men without a family history, nor did they report more cancer worries. They were more likely to report having a recent PSA test, but not a digital rectal exam. Having a higher than average perceived risk was associated with younger age, a college education, and lower mental well-being, and reporting more prostate cancer worries and being more likely to have had a recent PSA test. Although there continues to be controversy about PSA testing, these data suggest that African American men at above-average risk are inclined to be screened.

What Works? Preventing and Reducing Child Poverty in Europe

In most EU Member States children are at an above-average risk of living in poverty. Financial poverty is often only one aspect of a complex disadvantaged life situation that impacts on the development of children and limits their chances for participation. A growing number of EU Member States now recognise child poverty as a fundamental social problem and try to reduce high levels of child poverty. The European Commission explicitly supports and coordinates these efforts within the Open Method of Coordination. The examples of countries that are successful in either reducing high levels (like the UK) or in maintaining low levels of child poverty (like Sweden) show that the reduction of child poverty is not just a by-product of general anti-poverty policies but demands an explicit, multi-dimensional and integrated strategy. This should be based on the UN Convention on the Rights of the Child. As the fullest international expression of children's fundamental rights it offers a framework for the development, implementation and monitoring of child-related policies across Europe. The analysis of child- and family related policies in six EU Member States and the United States shows considerable diversity across these countries. Different welfare traditions have led to different strengths and weaknesses in addressing poverty and social exclusion among children, so they require different policy bundles to tackle child poverty and promote child well-being.

House Money Effect: Evidence from Market Makers at Taiwan Futures Exchange

We document empirical support for the 'house money' effect proposed by Thaler and Johnson (1990). Market makers for Taiwan' TAIEX index options tend to take above-average risks in afternoon trading after above-average morning gains. The fraction of market makers with better-than-average morning performance influences market-level liquidity and volatility in the afternoon trading. Our findings confirm that prior outcome influences subsequent risk-taking and emphasize that how investors frame previous outcomes influences their subsequent attitude toward risks.

Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin

Patients with metabolic syndrome (MS) have above-average risk of developing atherosclerosis and cardiovascular disease. Inflammation plays a key role in the development of atherosclerosis. High levels of the acute phase reactants C-reactive protein (CRP) and ferritin have been reported to correlate with various components of MS. The serum CRP, ferritin, glucose, insulin, triglycerides, HDL-cholesterol and total cholesterol concentrations of 598 obese or overweight patients were determined, together with relevant anthropometric parameters. Insulin resistance was evaluated by the HOMA method. MS was diagnosed using the ATP III criteria. CRP levels were higher among patients with central obesity than in those without (5.8 vs 3.9 mg/l; P=0.003), and higher among those with fasting plasma glucose concentrations >or=110 mg/dl than in those with lower concentrations (7.4 vs 4.1 mg/l; P=0.01). Serum ferritin levels were higher among patients with triglyceride concentrations >or=150 mg/dl than in those with lower levels (76.8 vs 40.1 ng/ml; P<0.001), and higher among those with fasting plasma glucose concentrations >or=110 mg/dl than in those with lower concentrations (75.7 vs 41.7 ng/ml; P=0.005). The number of MS criteria that were satisfied increased with CRP and ferritin levels. Patients with insulin resistance also had higher CRP and ferritin levels than those without, 7.3 vs 4.3 mg/l for CRP (P=0.032) and 124.5 vs 80.1 ng/ml for ferritin (P<0.001). MS and insulin resistance are associated with elevated serum CRP and ferritin. Evaluation of subclinical chronic inflammation in patients with MS and/or insulin resistance by determination of these markers might aid in their evaluation as candidates for aggressive intervention against cardiovascular risk factors.

The potential role of dentists in identifying patients' risk of experiencing coronary heart disease events

A substantial proportion of people with risk factors for cardiovascular disease (CVD) are not identified before they develop clinical signs and symptoms. A multidisciplinary approach that includes a cardiovascular screening by oral health care providers can affect the identification of people at risk of experiencing cardiovascular events. The authors extracted data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 2001-2002 NHANES for people aged 40 to 85 years with no reported specific risk factors for coronary heart disease (CHD) and who had not seen a physician in the previous 12 months but had seen a dentist. They used these data to estimate the 10-year Framingham-based risk calculation scores for each subject to determine their global risk of experiencing acute CHD events. Eighteen percent of the male subjects had an increased 10-year global risk of experiencing a CHD event (> 10 percent risk score), 14.3 percent had a moderate, above-average risk score (> 10-< 20 percent), and an additional 4.3 percent had a high risk score (> or = 20 percent). Only one female subject had a risk score greater than 10 percent. When the authors extrapolated these results to the 2000 U.S. census data, they found that among men aged 40 to 85 years without reported risk factors who had not seen a physician but had seen a dentist in the previous 12 months, 332,262 had a greater than 10 to less than 20 percent risk of experiencing a CHD event, and 72,625 had a 20 percent or greater 10-year risk of experiencing a CHD event. Dentists can play an important role in identifying people in need of primary prevention strategies for CVD.

Do‐it‐yourself diagnosis

Sandra Thomas is a trailblazer in the brave new world of genetic testing. Less than 5% of Americans have undergone a single genetic test, but the 56‐year‐old Florida woman has taken a dozen tests of the sort now available over the internet. Thomas is unmarried and has no children, but wanted to know if she has the mutation for haemochromatosis, the disease that killed her mother. Tests for two genes uncovered that she is a carrier of the potentially deadly but treatable iron‐overload disease. The tests also gave Thomas a passion for genetic testing in general. She found she has genes that put her at an above‐average risk for periodontal disease, which prompted her to improve her oral hygiene. The results of further tests, which she declined to name, have put her mind at ease about developing other serious conditions.(Fig 1) Figure 1. Some might consider Thomas a genetic‐testing hypochondriac, but she maintained, “I'm just ahead of my time.” Annette Taylor, a molecular geneticist and founder of Kimball Genetics (Denver, CO, USA), which runs genetics tests for major reference labs and now offers direct‐to‐consumer (DTC) testing, said, “Sandra is passionate about gathering information.” Testing for genetic disorders is becoming almost as easy as taking a home pregnancy test. People can use their credit card to order a kit on the internet, use a brush to remove a few cheek cells, return the kit and receive a report via e‐mail, often without involving their personal physicians. DTC tests cost from a few hundred to a few thousand US dollars, and are available for more than 800 conditions including breast and ovarian cancer, cystic fibrosis, coeliac disease, blood‐clotting disorders, dyslipidaemia, fragile X syndrome, Tay–Sachs disease and narcolepsy. > Testing for genetic disorders is becoming almost as easy as taking a home pregnancy test …

Barriers to minority participation in breast carcinoma prevention trials

Breast carcinoma prevention trials must recruit large cohorts of women who have an above-average risk of developing breast carcinoma. Recruitment for the Study of Tamoxifen and Raloxifene (STAR) trial required volunteers to complete a risk assessment questionnaire form (RAF). Women whose estimated risk of developing breast carcinoma in the next 5 years was > or = 1.67% based on the Gail model were invited to participate in STAR. Less than 4% of participants in the previously conducted P1 (tamoxifen vs. placebo) trial were minority women. We, therefore, studied barriers to minority participation in STAR among black, white, and Hispanic women who completed an RAF. The authors analyzed the association of Gail model risk factors, education, and insurance with race/ethnicity using chi-square tests and two-sided P values. They developed logistic regression models of trial eligibility, controlling for the Gail model risk factors, education, and insurance status. Among 823 women who completed an RAF, white women were 10 times as likely as Hispanic women and 45 times as likely as black women to be eligible for STAR. Age at first birth (P = 0.04), having an affected first-degree relative (P < 0.0001), having had a biopsy (P < 0.0001), education (P < 0.0001), and insurance status (P < 0.0001) varied by race/ethnicity. All variables except insurance status were associated with eligibility when race was excluded from the model. In a model that included race/ethnicity, the same factors remained statistically significant. These findings suggested that both the race/ethnicity adjustment and socioeconomic factors were barriers to eligibility for and contribute to low minority participation in breast cancer prevention trials.

Increasing colorectal cancer screening among individuals in the carpentry trade: test of risk communication interventions

Background Individuals in the carpentry trade, due to lifestyle habits and occupational exposures, may be at above-average risk for colorectal cancer (CRC). Based on the literature which suggests that increasing perceived risk motivates behavior change, we report on the effectiveness of four risk-communication interventions targeted to increase initial, yearly and repeat fecal occult screening (FOBT) among carpenters ( N = 860) over a 3-year period. Methods Our 2 × 2 factorial design intervention study varied two dimensions of providing CRC risk factor information: (1) type of risk factor—one set of interventions emphasized three basic risk factors (age, family history and polyps); the other set emphasized a comprehensive set of risk factors including basic, lifestyle, and occupational factors, and (2) tailoring/not tailoring risk factor information. Participants were provided FOBTs. Outcomes were the proportion of returned FOBTs. Results Varying the amount and intensity of delivering CRC risk factors information affected neither risk perceptions nor initial, yearly, or repeat screening. However, yearly and repeat screening rates were greater among participants who received interventions addressing comprehensive set of risk factors, especially with increasing age. Conclusions Tailoring on several CRC risk factors appears insufficient to increase and sustain elevated perceptions of CRC risks to promote screening.

Black cosmetologists promote diabetes awareness and screening among African American women.

his study evaluated several factors that were thought to contribute to African American women's disproportionate incidence and sequelae of diabetes. African American women (1055) living in San Diego County completed surveys about diabetes-related beliefs, screening behaviors, knowledge, and attitudes. Participants' ages ranged from 20 to 94 years, and 33.7% of the women reported completing college. Most of the women (59%) perceived diabetes to be a serious health threat to African American women. Thirty-two percent of the total sample and 37% of the high-risk group reported having been screened for diabetes within the past year. Nearly 37% reported never having been screened for diabetes, and 31% of those at above-average risk of developing diabetes could not recall ever having been screened. Women had a limited knowledge of the symptoms of diabetes, ways to decrease the risk factors and the sequelae of diabetes. Higher-risk women showed greater diabetes knowledge. Most participants reported that diabetes was a significant threat to their health but lacked sufficient knowledge to protect themselves from the disease. A focused, aggressive education campaign could yield better health outcomes.

Preparing for Climatic Change: The Water, Salmon, and Forests of the Pacific Northwest

The impacts of year-to-year and decade-to-decade climatic variations on some of the Pacific Northwest's key natural resources can be quantified to estimate sensitivity to regional climatic changes expected as part of anthropogenic global climatic change. Warmer, drier years, often associated with El Nino events and/or the warm phase of the Pacific Decadal Oscillation, tend to be associated with below-average snowpack, streamflow, and flood risk, below-average salmon survival, below-average forest growth, and above-average risk of forest fire. During the 20th century, the region experienced a warming of 0.8 °C. Using output from eight climate models, we project a further warming of 0.5–2.5 °C (central estimate 1.5 °C) by the 2020s, 1.5–3.2°C (2.3 °C) by the 2040s, and an increase in precipitation except in summer. The foremost impact of a warming climate will be the reduction of regional snowpack, which presently supplies water for ecosystems and human uses during the dry summers. Our understanding of past climate also illustrates the responses of human management systems to climatic stresses, and suggests that a warming of the rate projected would pose significant challenges to the management of natural resources. Resource managers and planners currently have few plans for adapting to or mitigating the ecological and economic effects of climatic change.

Do Sulfonamide Antibiotics and Non-Antibiotics Cross-React?

Your patient has a documented history of an allergic reaction to a sulfonamide antibiotic. Now you'd like to start the patient on a non-antibiotic drug with a sulfonamide moiety (e.g., a thiazide for hypertension or a sulfonylurea for diabetes). Is this patient at above-average risk for an allergic reaction …

Screening for bowel cancer among NSW adults with varying levels of risk: a community survey

To estimate the extent and modality of screening for colorectal cancer in NSW among community-dwelling adults aged over 40 with varying degrees of familial risk. Cross-sectional telephone survey with participants randomly selected from the electronic NSW telephone directory. 5.7% of people at average risk aged 40-49 report having had at least one faecal occult blood test (FOBT) in the previous five years, compared with 18.4% of those at average risk aged 50 and over. Of those at above-average risk (by age and familial risk), 7.9% reported that they had had an FOBT in the previous five years. Around 5% of respondents aged 40-49 and 10% of those aged 50+ reported having had a colonoscopy/sigmoidoscopy for screening within the previous five years, compared with 30% of those at above-average risk. People with medical insurance were more likely to have undergone a screening test (either FOBT or sigmoidoscopy/colonoscopy), than those without insurance (PR = 1.30; 95% CI 1.02-1.67). Compared with those employed full time, those who were retired (PR = 1.45 95% CI 1.01-2.09) and those who reported home duties (PR = 1.54 95% CI 1.01-2.36) were slightly, but significantly more likely to report having had a test. As perception of personal risk for colorectal cancer increased, so did the likelihood of having had a screening test within the previous five years (PR = 1.19; 95% CI 1.05-1.35). We have reported important baseline data with which to compare the progress of both pilot screening programs and more widespread implementation of colorectal screening in Australia. In particular, we have highlighted the need for greater participation in screening for those at increased familial risk.

Adecuación de la prescripción de hipolipemiantes y riesgo cardiovascular en pacientes con hipercolesterolemia

ObjectiveTo assess the appropriateness of lipid-lowering treatment and to determine the clinical and epidemiological characteristics of patients with hypercholesterolemia. MethodThe study population comprised all the patients diagnosed with hypercholesterolemia in three urban health centres. A sample of 724 patients was obtaind through a one-stage conglomerate method. A descriptive study was performed with two types of designs: retrospective and longitudinal, and crosssectional. For the first we used the new Sheffield tables for cardiovascular risk; for the second, the Framingham categorical tables (Grundy). ResultsAmong patients in primary prevention, prescription of lipid-lowering therapy was appropiate in 44.2%. A total of 8.9% (SE = 1.1) of the patients aged 30-74 years in primary prevention had a high absolute risk (. 20% over 10 years). Six percent (0.8) had a high relativd risk and 18.1% (2.0) had a moderately above-average risk. ConclusionsMore than the half of the patients were prescribed lipid-lowering treatment that was not indicated by risk tables. The current cardiovascular risk of our patients is satisfactory.

Who needs prophylaxis of nonsteroidal anti-inflammatory drug-induced ulcers and what is optimal prophylaxis?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used successfully by many patients for the treatment of the signs and symptoms of arthritis, and other painful and inflammatory disorders. However, traditional nonselective NSAIDs that inhibit COX-1 and COX-2 lead to a state of propensity for gastric and duodenal ulcer disease and ulcer complications. The point prevalence of endoscopic ulcers ranges from 14 to 44% of patients using NSAIDs. Moreover, it is estimated that 1.46-1.90% of chronic NSAID users develop serious upper gastrointestinal (UGI) toxicity annually, most notably UGI bleeding, gastric/duodenal obstruction or ulcer perforation. In the USA, it has been estimated that 107,000 hospitalisations and 16,500 deaths occur annually related to the use of nonselective NSAIDs. Because these ulcer complications are often not heralded by chronic symptoms of dyspepsia, symptoms alone are not sufficient to guide long-term management of NSAID-related toxicity. Instead, prophylactic and preventive therapies are recommended in patients at above-average and high risk. Epidemiological data have identified that patients with a past history of ulcer disease, past history of UGI bleeding, greater age, concomitant corticosteroid use, and those who use higher doses and multiple NSAIDs fall into this category. Other risk factors of lesser importance have also been identified. A controversial issue remains regarding the possible increased risk of NSAID-associated ulcers and ulcer complications in patients who are infected with Helicobacter pylori. Prophylactic therapies have been evaluated primarily in randomised clinical trials, with the rate of endoscopic ulcers as the primary endpoint. It is assumed, but not proven, that these endoscopic ulcer rates are surrogate markers for gastrointestinal toxicity and are predictive of the rate of significant UGI adverse events. In the only outcomes trial to date, it was reported that misoprostol (200 microg 4 times daily) caused an approximately 50% reduction in serious UGI adverse events in a large 6-month trial involving rheumatoid arthritis patients. In parallel, this approximates the 50% reduction of endoscopic ulcers seen in randomised controlled trials using misoprostol. While H2 receptor antagonists are ineffective agents at traditional doses, proton pump inhibitors have been clearly shown to reduce the rate of endoscopic ulcers in several trials. In fact, the efficacy approximates to the efficacy seen with misoprostol. Beyond efficacy and in practical terms, the choice of optimal prophylaxis should take into consideration patient compliance, patient satisfaction, side-effects and cost.

Colorectal cancer screening by general practitioners: comparison with national guidelines.

To determine whether general practitioners (GPs) had received Australian guidelines on early detection, screening and surveillance for colorectal cancer or rectal bleeding, and whether their reported practice conformed with these guidelines. Cross-sectional postal survey of self-reported practice. 213 GPs in practice in the southern metropolitan area of Perth, Western Australia, were randomly selected from the Fremantle Regional Division of General Practice database and surveyed in March 1997. Replies were received from 155 (73%) of the GPs, and 110 reported receiving guidelines (from the Australian Gastroenterology Institute [AGI], 44; Gut Foundation of Australia [GFA], 40; others, 6; and not specified, 20). GPs who reported receiving guidelines were significantly more likely to screen for colorectal cancer (99/110; 90%) than those who reported not receiving guidelines (33/45; 73%) (P = 0.008). The commonest method to investigate people with identifiable risk factors for colorectal cancer was colonoscopy. Reported screening frequencies in asymptomatic patients with above-average risk (family history of colorectal cancer or past history of adenomatous polyps or colorectal cancer) were significantly higher than recommended by AGI and GFA guidelines (P < 0.05). Up to 24% of GPs investigated altered bowel habit or bleeding per rectum with faecal occult blood testing. Most GPs report having received guidelines. Reported screening frequency was higher than recommended for most above-average-risk patients, which will result in excessive consumption of resources without benefits for cancer prevention.