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Promoting use of colorectal cancer screening tests

The most recent issue of the Journal of General Internal Medicine finds that an intervention to change physician behaviour has no effect on rates of colorectal cancer screening, but it does increase rates of sigmoidoscopy.

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Colorectal cancer screening is underutilized despite evidence that screening reduces mortality.

Dr Walsh and colleagues from California conducted a randomized clinical trial of community physicians and their patients.

The research team assessed the effect of an intervention targeting physicians and their patients on rates of colorectal cancer screening.

The team randomized 94 community primary care physicians to an intervention of academic detailing and direct mailings to patients or a control group.

Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician.

The patients also received a brochure on colorectal cancer screening, and a packet of fecal occult blood test cards.

After 1 year the team measured receipt of fecal occult blood tests in the past 2 years.

There was no increase in any colorectal cancer screening for patients enrolled for 2 or 5 years
Journal of General Internal Medicine

The researchers also measured flexible sigmoidoscopy or colonoscopy in the previous 5 years, and any colorectal cancer screening.

The percent change from baseline in both groups was reported.

The team enrolled 9652 patients for 2 years, and 3732 patients were enrolled for 5 years.

The researchers found no increase in any colorectal cancer screening that occurred in the intervention group for patients enrolled for 2 years.

Similar results were seen for any colorectal cancer screening among patients enrolled for 5 years.

The only outcome on which the team observed an effect by the intervention was on patient rates of screening sigmoidoscopy.

Dr Walsh's team concluded, “With the exception of an increase in rates of sigmoidoscopy in the intervention group, the intervention had no effect on rates of colorectal cancer screening.”

“Future interventions should assess innovative approaches to increase rates of colorectal cancer screening.”

J Gen Intern Med 2005: 2(34): doi: 10.1111/j.1525-1497.2005.0245.x
22 September 2005

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