Colorectal cancer screening and familial risk: a survey of internal medicine residents' knowledge and practice patterns.
OBJECTIVE
Risk stratification is essential to the appropriate use of colorectal cancer screening recommendations. The principal objective of this study was to assess the knowledge and screening behavior of internal medicine (IM) residents regarding familial colorectal cancer.


METHODS
We conducted a survey of IM residents in their second and third year of postgraduate training from two university-based programs (n = 127). The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with a family history of colorectal cancer, adenomatous polyps, familial adenomatous polyposis, and hereditary nonpolyposis colorectal cancer. The instrument also elicited data regarding familial risk assessment, documentation, and notification of at-risk family members.


RESULTS
Eighty-one IM eligible residents (81%) completed the survey. Most respondents identified a family history of colorectal cancer as an important factor in assessing colorectal cancer risk and appropriately implemented relevant screening recommendations. However, for patients with a family history of adenomatous polyps diagnosed before age 60 yr, knowledge and adherence to recommendations advocating screening at age 40 was relatively poor. More importantly, for patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, respondents lacked the necessary risk assessment skills and knowledge to appropriately implement current recommendations. There were no consistent differences in knowledge or screening behavior when stratified on the basis of program site or postgraduate year status.


CONCLUSIONS
Many IM residents are deficient in their knowledge, risk assessment skills, and screening practices for patients at familial risk of colorectal cancer. Effective educational strategies that promote awareness regarding familial risk, risk assessment skills, and appropriate use of relevant screening guidelines are needed.
Barrison
Adam F
AF
Department of Medicine, Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA.
Smith
Christopher
C
Oviedo
Jaime
J
Heeren
Timothy
T
Schroy
Paul C
PC
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D005260:Female; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007396:Internship and Residency; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires