Journal of General Internal Medicine

, Volume 28, Issue 1, pp 18–24

Variation in Primary Care Physicians’ Colorectal Cancer Screening Recommendations by Patient Age and Comorbidity

  • David A. Haggstrom
  • Carrie N. Klabunde
  • Judith Lee Smith
  • Gigi Yuan
Original Research

DOI: 10.1007/s11606-012-2093-6

Cite this article as:
Haggstrom, D.A., Klabunde, C.N., Smith, J.L. et al. J GEN INTERN MED (2013) 28: 18. doi:10.1007/s11606-012-2093-6



Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy.


To characterize the extent to which PCPs modify their recommendations for CRC screening based upon patients’ increasing age and/or worsening comorbidity


Cross-sectional, nationally representative survey.


The study comprised primary care physicians (n = 1,266) including general internal medicine, family practice, and obstetrics-gynecology physicians.


Physician CRC screening recommendations among patients of varying age and comorbidity were measured based upon clinical vignettes. Independent variables in adjusted models included physician and practice characteristics.


For an 80-year-old patient with unresectable non-small cell lung cancer (NSCLC), 25 % of PCPs recommended CRC screening. For an 80-year-old patient with ischemic cardiomyopathy (New York Heart Association, Class II), 71 % of PCPs recommended CRC screening. PCPs were more likely to recommend fecal occult blood testing than colonoscopy as the preferred screening modality for a healthy 80-year-old, compared to healthy 50- or 65-year-old patients (19 % vs. 5 % vs. 2 % p < 0.001). For an 80-year-old with unresectable NSCLC, PCPs who were an obstetrics-gynecology physician were more likely to recommend CRC screening, while those with a full electronic medical record were less likely to recommend screening.


PCPs consider comorbidity when screening older patients for CRC and may change the screening modality from colonoscopy to FOBT. However, a sizable proportion of PCPs would recommend screening for patients with advanced cancer who would not benefit. Understanding the mechanisms underlying these patterns will facilitate the design of future medical education and policy interventions to reduce unnecessary care.


cancer screening health services colorectal cancer primary care physicians 

Supplementary material

11606_2012_2093_MOESM1_ESM.doc (79 kb)
ESM 1(DOC 79 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • David A. Haggstrom
    • 1
    • 2
    • 3
  • Carrie N. Klabunde
    • 4
  • Judith Lee Smith
    • 5
  • Gigi Yuan
    • 6
  1. 1.VA Health Services Research & Development Center of Excellence on Implementing Evidence-Based PracticeRichard L. Roudebush VA Medical CenterIndianapolisUSA
  2. 2.Division of General Internal Medicine and Geriatrics, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  3. 3.IU Center for Health Services and Outcomes ResearchRegenstrief Institute, Inc.IndianapolisUSA
  4. 4.Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  5. 5.Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  6. 6.Information Management Services, Inc.Silver SpringUSA

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