Abstract
BACKGROUND
Little is known about physicians’ screening patterns for liver cancer despite its rising incidence.
OBJECTIVE
Describe physician factors associated with liver cancer screening.
DESIGN
Mailed survey.
PARTICIPANTS
Physicians practicing in family practice, internal medicine, gastroenterology, or nephrology in 3 northern California counties in 2004.
MEASUREMENTS
Sociodemographic and practice measures, liver cancer knowledge, attitudes, and self-reported screening behaviors.
RESULTS
The response rate was 61.8% (N = 459). Gastroenterologists (100%) were more likely than Internists (88.4%), family practitioners (84.2%), or nephrologists (75.0%) to screen for liver cancer in high-risk patients (p = 0.016). In multivariate analysis, screeners were more likely than nonscreeners to think that screening for liver cancer reduced mortality (odds ratio [OR] 1.60, CI 1.09–2.34) and that not screening was a malpractice risk (OR 1.88, CI 1.29–2.75). Screeners were more likely than nonscreeners to order any screening test if it was a quality of care measure (OR 4.39, CI 1.79–10.81).
CONCLUSIONS
Despite debate about screening efficacy, many physicians screen for liver cancer. Their screening behavior is influenced by malpractice and quality control concerns. More research is needed to develop better screening tests for liver cancer, to evaluate their effectiveness, and to understand how physicians behave when there is insufficient evidence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parkin DM, Whelan SL, Ferlay J, et al., eds. Cancer Incidence in Five Continents 1993–1997. Lyon, France: IARC Scientific Publications; 2002.
Ries LAG, Eisner MP, Kosary CL, et al., eds. SEER Cancer Statistics Review, 1973–1998. Bethesda, MD: National Cancer Institute; 2001.
Sherman M. Screening for hepatocellular carcinoma. Bailliere’s Best Pract Res Clin Gastroenterol. 1999;13(4):623–35.
Sakuma KS, Kasai M, Jitsukawa H, et al. Relative risks of death due to liver disease among Japanese male adults having various statuses for hepatitis B s and e antigen/antibody in serum: a prospective study. Hepatology. 1988;8(6):1642–6.
Morris CR, Cohen R, Perkins CI, et al. Cancer in California 1988–1996. Sacramento, CA: California Department of Health Services, Cancer Surveillance Section; 1999.
Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2001;34(6):1225–41.
De Masi S, Tosti ME, Mele A. Screening for hepatocellular carcinoma. Dig Liver Dis. 2005;37(4):260–8.
National Cancer Institute. Hepatocellular (Liver) Cancer Screening. Available at: http://www.cancer.gov/cancertopics/pdq/screening/hepatocellular/HealthProfessional. Accessed October 28, 2005.
Lok AS, McMahon BJ. American Association for the Study of Liver Diseases (AASLD) Practice Guidelines: Chronic Hepatitis B. Available at: https://www.aasld.org/. Accessed October 28, 2005.
Chalasani N, Said A, Ness R, et al. Screening for hepatocellular carcinoma in patients with cirrhosis in the United States: results of a national survey. Am J Gastroenterol. 1999;94(8):2224–9.
Lee MM, Lee F, Stewart S, et al. Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco. West J Med. 1999;170(3):148–55.
Lew AA, Moskowitz JM, Ngo L, et al. Effect of provider status on preventive screening among Korean-American women in Alameda County, California. Prev Med. 2003;36(2):141–9.
Fowler FJ Jr., Bin L, Collins MM, et al. Prostate cancer screening and beliefs about treatment efficacy: a national survey of primary care physicians and urologists. Am J Med. 1998;104(6):526–32.
Voss JD, Schectman JM. Prostate cancer screening practices and beliefs. J Gen Intern Med. 2001;16(12):831–7.
Pateron D, Ganne N, Trinchet JC, et al. Prospective study of screening for hepatocellular carcinoma in Caucasian patients with cirrhosis. J Hepatol. 1994;20(1):65–71.
Zoli M, Magalotti D, Bianchi G, et al. Efficacy of a surveillance program for early detection of hepatocellular carcinoma. Cancer. 1996;78(5):977–85.
McMahon BJ, Bulkow L, Harpster A, et al. Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: a 16-year population-based study. Hepatology. 2000;32(4 Pt 1):842–6.
Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130(7):417–22.
Chen JG, Parkin DM, Chen QG, et al. Screening for liver cancer: results of a randomised controlled trial in Qidong, China. J Med Screen. 2003;10(4):204–9.
Collins MM, Fowler FJ Jr., Roberts RG, et al. Medical malpractice implications of PSA testing for early detection of prostate cancer. J Law Med Ethics. 1997;25(4):234–42.
Acknowledgment
This study was funded by a Cancer Control Career Development Award (CCCDA-02-221-01) from the American Cancer Society. Drs. Nguyen and McPhee were also supported by the Asian-American Network for Cancer Awareness, Research, and Training (National Cancer Institute U01/CA86322).
Potential Financial Conflict of Interest
None disclosed
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nguyen, T.T., Gildengorin, G., Truong, A. et al. Factors Influencing Physicians’ Screening Behavior for Liver Cancer Among High-risk Patients. J GEN INTERN MED 22, 523–526 (2007). https://doi.org/10.1007/s11606-007-0128-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-007-0128-1