WASHINGTON — Most primary care physicians in West Virginia believe that their resources are adequate for colorectal cancer screening despite perceived barriers including patient inconvenience and physician reimbursement, Cathy A. Coyne, Ph.D., reported in a poster presented at the annual meeting of the American College of Preventive Medicine.
Dr. Coyne, of the department of community medicine at West Virginia University, Charleston, compared the attitudes and practices of West Virginia physicians with a national survey conducted by the National Cancer Institute in 2000.
In a survey of 569 West Virginia-based primary care physicians, more than 96% said that they recommended colorectal cancer screening to average-risk patients. Of these, 31% reported recommending a colonoscopy, compared with 3%-13% of primary care doctors who responded to the NCI survey. By contrast, 7.5% of the West Virginia doctors reported recommending a fecal occult blood test, compared with 22%-30% of doctors in the NCI survey. Although 19% of West Virginia physicians reported using a digital rectal exam plus a fecal occult blood test in their offices, the NCI survey did not include a DRE, since it is not a nationally recommended screening method.
The U.S. Agency for Healthcare Research and Quality recommends colorectal screening for all average-risk adults aged 50 years and older using any of several methods including fecal occult blood testing every year, flexible sigmoidoscopy every 5 years, combined use of fecal occult blood testing every year and flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, or colonoscopy every 10 years.
Colonoscopy was the most frequently recommended screening method, but it was also the procedure most often associated with barriers. Nearly 60% of the West Virginia physicians reported patient inconvenience as a barrier to colonoscopy, 47% reported patient refusal or poor compliance, and 39% reported reimbursement problems. Test inconvenience for patients, patient refusal or poor compliance, and physician reimbursement were also the most common barriers to fecal occult blood tests and flexible sigmoidoscopy reported by the physicians.
Given these perceived barriers, “we were surprised that most of the doctors reported that their capacity to conduct colorectal screening was sufficient to meet the local demand,” Dr. Coyne said in an interview.
Although 77% of the physicians reported that more than 50% of their patients were complying with recommended colorectal screening guidelines, data from the 2001 Behavioral Risk Factor Surveillance System in West Virginia show that only 30% of adults aged 50 years and older were screened for colorectal cancer.