Primary care physicians and internal medicine residents have poor understanding of colorectal cancer screening and the use of fecal occult blood tests. If acceptance and implementation of colorectal cancer screening is to improve, gastroenterologists may have to take a more leading role in the education of their primary care colleagues, physicians in training, and the general public. However, before this can be recommended, it is necessary to determine how closely gastroenterologists follow currently recommended guidelines and how they use fecal occult blood tests.
We mailed a two-page, structured questionnaire about colorectal cancer screening and use of fecal occult blood tests to 8000 randomly selected gastroenterologists in the United States.
We received responses from 24% of the gastroenterologists. Almost all used fecal occult blood tests in the office setting, 86% on stool obtained at rectal examination. The test was frequently used for reasons other than colorectal cancer screening, and often without adequate patient instruction on dietary and medication restrictions. Of the respondents, 98% commenced screening at age ≤50 yr, whereas 37% either continued screening into advanced age or never stopped. Annual fecal occult blood testing with flexible sigmoidoscopy every 5 yr was the screening strategy recommended by 71% of the respondents, whereas 25% recommended colonoscopy every 10 yr. However, 77% of the gastroenterologists chose colonoscopy for personal colorectal cancer screening.
Gastroenterologists usually give appropriate advice on colorectal cancer screening but often misuse fecal occult blood tests. This may produce excessively high false-positive screening rates, leading to unnecessary diagnostic testing without apparent benefit.
1Division of Digestive Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
2Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
Reprint requests and correspondence: Colin W Howden, MD, FACG, Northwestern University, Northwestern Center for Clinical Research, 680 North Lake Shore Drive, Suite 1220, Chicago, IL 60611
Received February. 29, 2000; accepted August. 16, 2000
This work was presented at the 64th Annual Meeting of the American College of Gastroenterology in Phoenix, AZ, October 18–20, 1999, and was published in abstract form (Am J Gastroenterol 1999;94:2686).