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Agency for Healthcare Research Quality

Primary Care

Majority of primary care physicians now recommend colonoscopy

About 95 percent of primary care physicians routinely recommend screening colonoscopy to patients with average risk for colorectal cancer (CRC). Procedures once recommended in the past, such as sigmoidoscopy (where only a third of the colon is examined), are now only rarely suggested to patients, reveals a new study.

Researchers analyzed responses from 1,266 primary care physicians who responded to a 2006-2007 survey on recommendations and practices for colorectal and other commonly screened cancers. Results were then compared with responses from an earlier nationwide survey conducted in 1999-2000. Whereas 86 percent of physicians in the earlier survey perceived colonoscopy to be very effective at reducing mortality from CRC, 95 percent felt this way in the latest survey.

In the older survey, the fecal occult blood test (FOBT) was the screening modality most recommended (95 percent). Colonoscopy was a distant third at only 38 percent, behind sigmoidoscopy (78 percent). Now, 95 percent of primary care physicians routinely recommend colonoscopy, followed by FOBT (80 percent) and sigmoidoscopy (26 percent). There has been a 25 percent drop in the number of primary care physicians who perform flexible sigmoidoscopies. While many have been trained in the procedure, they now only rarely recommend or perform it, note the researchers.

The U.S. Preventive Services Task Force on CRC screening recommends, but does not distinguish among, all three procedures. According to the latest survey, the majority of primary care physicians recommend age 50 years for the start of CRC screening, with colonoscopy performed once every 10 years. Close to two-thirds (61 percent) of physicians reported having implemented guidelines for CRC screening.

See "Colorectal cancer screening by primary care physicians: Recommendations and practices, 2006-2007," by Carrie N. Klabunde, Ph.D., David Lanier, M.D., Marion R. Nadel, Ph.D., and others, in the July 2009 American Journal of Preventive Medicine 37(1), pp. 8-16. Reprints (AHRQ Publication No. 09-RA076) are available from the AHRQ Publications Clearinghouse.

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