, Volume 1, Issue 5, pp 275-281

Performance of cancer screening in a university general internal medicine practice

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Abstract

The authors evaluated use of seven cancer screening tests by 52 providers in a university general internal medicine practice, using 1980 American Cancer Society (ACS) recommendations as standards for comparison. Performance rates were determined by retrospective medical record reviews of a stratified random sample of 525 patients. In addition, the 48 physicians and four nurse-practitioners in the practice were interviewed to determine their opinions, knowledge and perceived use of the tests. Performance rates were low, significantly below the ACS quidelines for all tests except Pap smear. Providers used the tests significantly more often to evaluate patients with cancer risk factors or for new patients. They significantly overestimated their own performances of six tests. More than a fourth of the providers disagreed with the use of mammography, sigmoidoscopy, pelvic or rectal examinations for screening asymptomatic adults. Their knowledge about cancer screening and the ACS recommendations was highly variable, and frequently quite limited. Providers offered four major reasons for not performing the screening tests: provider forgetfulness, lack of time, inconvenience and logistical difficulties, and patient discomfort or refusal.

Received from the Division of General Internal Medicine, Department of Medicine, and Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.
Presented in part at the 111th annual meeting of the American Public Health Association, Dallas, Texas, November 1983, and at the 8th annual meeting of the Society for Research and Education in Primary Care Internal Medicine, Washington, D.C., May 1985.
Supported by the Robert Wood Johnson Foundation and by PHS grant number 5 R01 CA37340, awarded by the National Cancer Institute, DHHS.
Steven Schroeder, MD, Bernard Lo, MD, Steven Cummings, MD, Thomas Coates, PhD, Eliseo Perez-Stable, MD, Hal Luft, PhD, and Joyce Bird, PhD, provided helpful comments. The faculty and residents of the Division of General Internal Medicine and the General Internal Medicine Group Practice at the University of California, San Francisco, provided their interest and cooperation. Richard Meltzer, Matthew Boone, MD, and William Cunningham, MD, assisted in obtaining data.