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Colorectal cancer screening: a retrospective study of compliance with guidelines in a university-based primary care practice

Ashish Malhotra MD

Aim Colorectal cancer is the third most common cancer in the US. Randomised trials have demonstrated the efficacy of screening. Our goal was to determine the compliance among primary care physicians with the American Cancer Society screening guidelines for colorectal cancer and secondarily to determine the reasons for non-compliance.Methods Two-hundred and twenty-one medical records were randomly selected for this retrospective cohort review. The  identification of records was determined by inclusion criterion: (1) all patients born 1950 or before irrespective of co-morbidities;(2) first visit to the clinic in 2000; (3) most recent visit after December 2003, so as to exclude patients who dropped out of the practice or died. The records were examined to answer the following: (1) was screening offered when it was indicated? A 2-year period to complete screening was permitted; (2) was screening completed by any of the approved methods either on time or late? (3) Were abnormal/normal results followed-up according to the guidelines? We allowed a 2-year follow up period. If the answer to any of the above was ‘no’, non-compliance was recorded and possible reasons for non-compliance were searched in the medical record.Results Altogether, 55.6% of the patients were offered screening when it was indicated; 66.5% completed screening either late or on time; abnormal or normal results were followed according to guidelines in 59.2%; and 33.0% had documented compliance. The most common explanation for non-adherence was ‘unknown’, i.e. the medical record did not provide an explanation (79%),19.6% declined any screening and 1.4% were noncompliant because of lack of insurance or the presence of co-morbid conditions.Conclusions The compliance rate in this internal medicine practice was 33.0%. The reasons for noncompliance for the most part remain unknown, but there was substantial patient refusal to be screened,suggesting room for improvement either in patientor physician education, or in documenting recommendations and results.