title: Colorectal cancer screening practise is influenced by ethnicity of medical practitioner and patient.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening improves survival and requires appropriate recommendation by general practitioners (GPs). Screening practises may be influenced by barriers related to ethnicity and training.
  
  
  METHODS
  A mail survey assessed GPs' practises and the barriers towards CRC screening. The association of screening practises and demography, including GP ethnicity, medical training and practise characteristics, were evaluated.
  
  
  RESULTS
  Of 212 GPs (median age 54 years, 73% men, 27% Caucasian, 38% foreign graduates), 87% agreed that fecal occult blood test (FOBT) screening improved survival in the average-risk patient. Considerable variations existed in the starting age (40-49 years: 31%; 50 years: 65%) and frequency (1-2 years: 77%; 3-5 years: 22%) of screening. FOBT was used for indications other than screening: anemia (59%), altered bowel habits (54%), abdominal pain (24%), and rectal bleeding (23%), and these were significantly more frequent in Asian GPs independent of medical training. GPs were less likely to recommend screening to immigrants, and most reported that immigrants were less likely to participate. More Asian and Middle Eastern GPs reported a major barrier with FOBT inaccuracy compared with Caucasian GPs (22% vs 9%, P = 0.03; and 27% vs 9%, P = 0.03, respectively).
  
  
  CONCLUSIONS
  Considerable differences existed in GPs' CRC screening practises. Indications for use of FOBT and the subsequent investigation of a positive FOBT also varied according to GPs' ethnicity, independent of medical training. Patient's ethnicity and associated language and cultural barriers may affect screening uptake, which may negatively affect the health of immigrants. Resources and culture-specific interventions are recommended to improve overall screening participation.
authors.affiliation: Gastroenterology and Liver Services, Sydney South West Area Health Service, Sydney, New South Wales, Australia. kenjhkoo@yahoo.com.au
authors.forename: Jenn Hian
authors.initials: JH
authors.lastname: Koo
authors.forename: Matthew Yibin
authors.initials: MY
authors.lastname: You
authors.forename: Ken
authors.initials: K
authors.lastname: Liu
authors.forename: Maneesha D
authors.initials: MD
authors.lastname: Athureliya
authors.forename: Catherine W Y
authors.initials: CW
authors.lastname: Tang
authors.forename: Diane M
authors.initials: DM
authors.lastname: Redmond
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Connor
authors.forename: Rupert W L
authors.initials: RW
authors.lastname: Leong
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel / Q000208:ethnology*; D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003466:Cultural Characteristics; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010361:Patients / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires