Survey of colorectal cancer screening practices in a large Canadian urban centre.

INTRODUCTION: Colorectal carcinoma (CRC) is an ideal tumour for population-based screening policies. Screening guidelines are based on differing levels of evidence and opinion. The objective of this study was to determine current CRC screening practices in Alberta.
METHODS: A questionnaire was mailed to all family physicians, gastroenterologists, general and colorectal surgeons, and general internal medicine specialists in a large Canadian urban centre. Results tabulated included response rate, specialty, presence/absence of a screening policy, and policy type.
RESULTS: The 922 surveys mailed resulted in a 61% response rate. Among the responses, 58% (95% confidence interval [CI] 53.6%-62.6%) of physicians recommended screening to healthy individuals without a family history of CRC, and 96% (CI 94.7%-98%; p < 0.0001) to those with a family history. For patients without a family history of CRC, the majority of physicians chose the age of 50 to initiate screening (63%) by fecal occult blood testing (79%) or, less frequently, colonoscopy (26%). Screening frequency varied by the modality used. In individuals with a family history of CRC, most physicians initiated screening prior to the index case (45%) or by age 40 (31%), mostly with colonoscopy (84%); screening frequency varied mainly by modality.
CONCLUSION: Despite the evidence supporting CRC screening in all persons at average risk, only 58% of physicians currently recommend screening to patients with no family history of CRC. Fecal occult blood testing was recommended most frequently in this subgroup, whereas most physicians screen people with a family history of CRC via colonoscopy, suggesting that they believe it to be a superior screening modality. As this looks to be the trend in practice, a randomized controlled trial comparing fecal occult testing with screening colonoscopy is needed.