Fecal occult blood testing beliefs and practices of U.S. primary care physicians: serious deviations from evidence-based recommendations.
BACKGROUND
Fecal occult blood testing (FOBT) is an important option for colorectal cancer screening that should be available in order to achieve high population screening coverage. However, results from a national survey of clinical practice in 1999-2000 indicated that many primary care physicians used inadequate methods to implement FOBT screening and follow-up.


OBJECTIVE
To determine whether methods to screen for fecal occult blood have improved, including the use of newer more sensitive stool tests.


METHODS
Cross-sectional national survey of primary care physicians.


METHODS
Participants consisted of 1,134 primary care physicians who reported ordering or performing FOBT in the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Cancer Screening.


METHODS
Self-reported data on details of FOBT implementation and follow-up of positive results.


RESULTS
Most physicians report using standard guaiac tests; higher sensitivity guaiac tests and immunochemical tests were reported by only 22.0% and 8.9%, respectively. In-office testing, that is, testing of a single specimen collected during a digital rectal examination in the office, is still widely used although inappropriate for screening: 24.9% of physicians report using only in-office tests and another 52.9% report using both in-office and home tests. Recommendations improved for follow-up after a positive test: fewer physicians recommend repeating the FOBT (17.8%) or using tests other than colonoscopy for the diagnostic work-up (6.6%). Only 44.3% of physicians who use home tests have reminder systems to ensure test completion and return.


CONCLUSIONS
Many physicians continue to use inappropriate methods to screen for fecal occult blood. Intensified efforts to inform physicians of recommended technique and promote the use of tracking systems are needed.
Nadel
Marion R
MR
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K55, Atlanta, GA 30341, USA. mrn1@cdc.gov
Berkowitz
Zahava
Z
Klabunde
Carrie N
CN
Smith
Robert A
RA
Coughlin
Steven S
SS
White
Mary C
MC
D000328:Adult; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States
Gastroenterology. 2008 May;134(5):1570-95
18384785
Cancer Epidemiol Biomarkers Prev. 2006 Feb;15(2):389-94
16492934
Am J Prev Med. 2008 Jul;35(1 Suppl):S34-55
18541187
J Med Screen. 2003;10(3):117-22
14561262
Ann Intern Med. 2005 Jan 18;142(2):81-5
15657155
J Clin Gastroenterol. 2008 Nov-Dec;42(10):1089-94
18936643
Cancer Epidemiol Biomarkers Prev. 2008 Jul;17(7):1623-30
18628413
N Engl J Med. 1993 May 13;328(19):1365-71
8474513
N Engl J Med. 2000 Nov 30;343(22):1603-7
11096167
Ann Intern Med. 2005 Jan 18;142(2):86-94
15657156
CA Cancer J Clin. 2002 Jan-Feb;52(1):8-22
11814067
CA Cancer J Clin. 1997 May-Jun;47(3):154-60
9152173
Gastroenterology. 2003 Feb;124(2):544-60
12557158
Am J Prev Med. 2009 Jul;37(1):8-16
19442479
Lancet. 1996 Nov 30;348(9040):1467-71
8942774
Gastroenterology. 1997 Feb;112(2):594-642
9024315
J Natl Cancer Inst. 2007 Oct 3;99(19):1462-70
17895475
CA Cancer J Clin. 1980 Jul-Aug;30(4):193-240
6774802
Ann Intern Med. 2008 Nov 4;149(9):627-37
18838716
J Gen Intern Med. 2008 Feb;23(2):169-74
18157581
Ann Fam Med. 2009 Jan-Feb;7(1):11-6
19139444
Ann Intern Med. 2008 Nov 4;149(9):659-69
18838717
Obstet Gynecol. 2006 Dec;108(6):1611-3
17138803
Ann Intern Med. 2002 Jul 16;137(2):129-31
12118971
Gastrointest Endosc. 2007 May;65(6):757-66
17466195
Ann Intern Med. 2005 Jan 18;142(2):146-8
15657163
J Gen Intern Med. 2009 Mar;24(3):356-60
19130147
CA Cancer J Clin. 2006 May-Jun;56(3):143-59; quiz 184-5
16737947
Ann Intern Med. 2008 Nov 4;149(9):638-58
18838718
J Am Geriatr Soc. 2008 Aug;56(8):1511-6
18662217
CA Cancer J Clin. 2003 Jan-Feb;53(1):44-55
12568443
Med Care. 2007 Feb;45(2):160-7
17224779
Lancet. 1996 Nov 30;348(9040):1472-7
8942775