Primary care physicians' awareness and implementation of screening guidelines for colorectal cancer.

Objective: The objective was to determine primary care physicians' (PCPs) familiarity and implementation of screening guidelines for colorectal cancer (CRC) in central Israel.

Methods: Fifty PCPs were interviewed and 1000 charts of their asymptomatic patients ages 50-70 were examined. All CRC patients treated at the regional Oncology Institute in 1980-1984 and in 1993-1997 were then compared, with emphasis on the event leading to diagnosis and tumor stage.

Results: Almost all PCPs endorsed screening. Fecal occult blood testing (FOBT) was appropriately recommended by 40% (annually), and the use of flexible sigmoidoscopy (FS) was appropriately recommended by 12% of physicians (every 3-5 years). Only four (8%) were correct in the use of both techniques. Most PCPs estimated that >25% of their patients had been screened for CRC. In fact, 92/1,000 had FOBT (9.2%), 14/1,000 had screening FS (1.4%), and 3 patients only had both tests. Only 1.2% of CRC diagnoses in the 1980s (n = 175) and 2.6% in the 1990s (n = 343) were established as a result of screening (P > 0.25, NS). Tumor stage distribution at diagnosis was similar.

Conclusions: PCPs studied endorse CRC screening but they are not familiar with accepted guidelines and do very little about implementing them, and this has not changed much over the past decade. CRC screening has a potential to markedly decrease mortality, yet the best screening strategy is worthless without physician education and compliance.