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Colorectal cancer screening ‘needs buy-in’

By Lilian Anekwe

Population-based screening for colorectal cancer will only succeed if GPs are positively engaged and enthusiastic about the programme, a survey of GP of 1,000 GPs by researchers at the University of Birmingham has concluded.

A survey of nearly 1,000 UK GPs into attitudes towards colorectal cancer screening and the use of faecal occult blood testing (FOBt) in routine practice found that while 95% felt the screening programme was effective in reducing mortality, only 78% felt FOBt was effective – far fewer than mammography and cervical smears. Half felt that FOBt was a ‘very appropriate' test while 8% felt it was inappropriate.

An assessment of attitudes towards FOBt using a minimum score of three, for very negative attitudes and nine for and a very positive one, found GPs felt largely ambivalent towards the test, with an average of 5.9 amongst the 960 GPs surveyed.

GPs stated there were several ‘system-related' barriers that prevented them recommending screening to patients, including the lack of trained healthcare providers to conduct screening and investigate positive FOB tests, both reasons cited by more than half of GPs.

Study lead Dr Sarah Damery, a research fellow at the University of Birmingham concluded: ‘The positive engagement of GPs with colorectal cancer screening, and with FOBt in particular, is required if screening uptake rates are to reach acceptable levels, and the projected colorectal cancer reductions observed in randomised controlled trials of FOBt screening are to be achieved in practice.

But Dr Willie Hamilton, a GP in Exeter and cancer diagnosis researcher, said it would need GP engagement, as well as other factors, to increase UK cancer detection rates of colorectal cancer.

‘There is limited room for increasing the uptake greatly and only 10% of cancers are currently identified that way. I suppose this may rise a little, but it isn't going to crack the UK's poor performance on its own.'

BMC Family Practice 2010, 11:20


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