A review of patient and physician adherence to colorectal cancer screening guidelines

This article reviews the published literature on individuals' completion of recommended colorectal cancer (CRC) screening with fecal occult blood testing (FOBT) and sigmoidoscopy, as well as physicians' adherence to screening guidelines for asymptomatic persons at population risk for CRC. Studies of patient, community-based, and employed populations show wide variability in the prevalence of adherence to FOBT, with a median rate of 40% to 50%. Fewer studies examined sigmoidoscopy in similar populations, and adherence rates for this procedure were lower than for FOBT. Similarly, studies of physicians showed a wide variability in adherence to FOBT guidelines, and there is evidence to indicate that physicians may overreport their frequency of screening patients with FOBT. There was less variability in physicians' adherence to screening guidelines relating to sigmoidoscopy, which was lower overall. Intensive, personalized interventions may facilitate both individuals' initial uptake of screening, as well as the continuation of screening behavior. Interventions that influence practice and organizational characteristics may be most effective in increasing physicians' recommendation of age-appropriate screening tests. Empiric evidence indicates that among both physicians and patients, adherence to CRC screening is inconsistent and may deviate from what the guidelines recommend. Future efforts must be directed toward increasing performance and uptake of initial screening offers, as well as maintenance of regular screening for CRC. (C) 2000 by W.B. Saunders Company.