The Mount Sinai Journal of Medicine - Mount Sinai School of Medicine

Volume 72 Number 1 January 2005	back to contents

Barriers to Colorectal Cancer Screening: Inadequate Knowledge by Physicians	36-44
Melissa Gennarelli, M.D.1, Lina Jandorf, M.A.1, Caroline Cromwell, M.D.1, Heiddis Valdimarsdottir, Ph.D.1, William Redd, Ph.D.1, and Steven Itzkowitz, M.D.2

From the 1Derald H. Ruttenberg Cancer Center, and 2Department of Medicine, Mount Sinai School of Medicine, One East 100th Street, New York, NY.

Address all correspondence to: Lina Jandorf, M.A., Box 1130, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029; email: lina.jandorf@mssm.edu

This study was supported by NCI grants U01-CA86107 and R25-CA81137

Accepted for publication April 2004.

Abstract

Background: The rate of colorectal cancer (CRC) screening remains relatively low. One potential barrier to higher rates is the lack of physician knowledge regarding CRC screening. The purpose of this study was to assess physicians’ knowledge of (a) American Cancer Society (ACS) CRC screening guidelines for average-risk and high-risk patients, and (b) general colorectal cancer facts which support these guidelines.

Methods: We administered a questionnaire to internal medicine residents, internal medicine attendings and medical students who provide care to patients in a low-income, predominantly minority community, to compare their levels of knowledge regarding CRC screening. Mean knowledge scores were calculated based on the number of correct responses.

Results: Knowledge of ACS guidelines for average-risk patients was low, although it did increase directly with level of training: medical students obtained a mean score of 32%, residents 49%, and attendings 56% (p<0.001). Knowledge scores for high-risk patients were even lower, with fewer than half of the respondents offering correct answers. Mean knowledge scores of general CRC screening facts increased with level of training: medical students scored 31%, residents 38% and attendings 42% (p<0.001).

Clinical Implications: Knowledge of CRC screening guidelines for both average- and high-risk patients was suboptimal among the medical students, residents and attendings studied. Lack of knowledge about CRC is one barrier to screening that may contribute to underutilization of screening for minority populations. Further educational efforts should be targeted to these health care professionals.

KEYWORDS

Colorectal cancer, cancer screening, ethnic minorities, colonoscopy, sigmoidoscopy, fecal occult blood test, ACS guidelines.

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