title: Old habits die hard: chest radiography for screening purposes in primary care.
abstract: 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.
authors.affiliation: Section of Oncology and Public Health, Panhellenic Association for Continual Medical Research, Athens, Greece. pacmer_science@yahoo.com
authors.forename: Davide
authors.initials: D
authors.lastname: Mauri
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kamposioras
authors.forename: Anastasios
authors.initials: A
authors.lastname: Proiskos
authors.forename: Apostolos
authors.initials: A
authors.lastname: Xilomenos
authors.forename: Christina
authors.initials: C
authors.lastname: Peponi
authors.forename: Mario
authors.initials: M
authors.lastname: Dambrosio
authors.forename: Georgios
authors.initials: G
authors.lastname: Zacharias
authors.forename: Georgios
authors.initials: G
authors.lastname: Koukourakis
authors.forename: George
authors.initials: G
authors.lastname: Pentheroudakis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
mesh_terms: 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