Old habits die hard: chest radiography for screening purposes in primary care.
OBJECTIVE
To assess whether the use of chest radiography for screening changes over time.


METHODS
Systematic review.


METHODS
MEDLINE, ISI, Cochrane Central Register of Controlled Trials, and handsearching of selected journals.


METHODS
We evaluated whether the proportion of primary care physicians using chest radiography to screen for (1) malignancy in the general asymptomatic population, (2) malignancy in a high-risk subgroup, (3) any disease in the general population, and (4) any disease in a high-risk subgroup changed over time, using random-effects meta-regression analysis. Adjustments for the availability of national guidelines were also performed.


RESULTS
Overall, 10% to 90% of primary care physicians reported using chest x-ray for screening. In unadjusted analyses, the proportion of physicians using chest radiography for cancer screening in the general population tended to increase by 0.9% per year (8 studies, n = 4313). The corresponding annual changes were -2.9% for cancer screening in high-risk subgroups (8 studies, n = 2784) and -0.4% regarding screening for any disease in the population (7 studies, n = 2627). No meta-regressions were run for outcome (4) (only 1 study). In the adjusted analyses, there was a decreasing nonsignificant trend for all outcomes.


CONCLUSIONS
Despite formal recommendations, many physicians still use chest x-ray for screening, with their number decreasing slowly over time. This practice may be harmful because the positive predictive value of chest radiography is low, and further evaluation of false-positive findings might be associated with increased cost and risk from additional diagnostic or therapeutic interventions.
Mauri
Davide
D
Section of Oncology and Public Health, Panhellenic Association for Continual Medical Research, Athens, Greece. pacmer_science@yahoo.com
Kamposioras
Konstantinos
K
Proiskos
Anastasios
A
Xilomenos
Apostolos
A
Peponi
Christina
C
Dambrosio
Mario
M
Zacharias
Georgios
G
Koukourakis
Georgios
G
Pentheroudakis
George
G
Pavlidis
Nicholas
N
D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000639:trends*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D018570:Risk Assessment