Screening for colorectal cancer on the front line

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Family Medicine and Community Health; Division of General Medicine, UMass Memorial Health Care

Publication Date


Document Type



Aged; *Attitude of Health Personnel; Clinical Competence; Colorectal Neoplasms; Culture; Female; Guideline Adherence; Health Knowledge, Attitudes, Practice; Humans; Male; *Mass Screening; Medicare; Middle Aged; Patient Acceptance of Health Care; Physician's Practice Patterns; Physicians, Family; Practice Guidelines as Topic


Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Preventive Medicine


OBJECTIVE: The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening.

METHODS: We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening.

RESULTS: Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong.

CONCLUSIONS: Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.

DOI of Published Version



Am J Gastroenterol. 2003 Apr;98(4):915-23. Link to article on publisher's site

Journal/Book/Conference Title

The American journal of gastroenterology

Related Resources

Link to Article in PubMed

PubMed ID