Screening practice and misplaced priorities.

PURPOSE: To estimate cancer screening coverage among a large sample of Greek individuals. METHODS: 7012 adults from 30 Hellenic areas were surveyed. Tests included: faecal occult blood test, sigmoidoscopy,chest X-ray, urine test, testicular examination,trans-rectal ultrasound, full blood count, skin examination,digital rectal examination, PSA, Pap test, mammography,clinical breast examination (CBE), self breast examination and breast ultrasound. RESULTS: Eighty-eight percent of males and 93% of females declared being interested in cancer screening; 37.8% of men and 37.9% of women had had a medical consultation for screening purpose in the previous 2 years. Less than 2%reported having received screening for colorectal cancer or skin malignancies. Screening for cervical cancer, mammography and CBE was reported by 39.6%, 22.8% and 27.9% of females respectively. Twenty percent of males reported screening for prostate cancer. CONCLUSION: The actual opportunistic screening approach presents important deficiencies with displaced priorities in test performance and a low proportion of individuals undergoing recommended tests.

Time-trend of melanoma screening practice by primary care physicians: a meta-regression analysis.

OBJECTIVE: To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time. METHODS: Meta-regression analyses of available data. DATA SOURCES: MEDLINE, ISI, Cochrane Central Register of Controlled Trials. RESULTS: Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%-82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were -0.68% (P =0.494), -2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines. CONCLUSIONS: Considering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon.

Cancer screening in Greece. Guideline awareness and prescription behavior among Hellenic physicians.

BACKGROUND: Primary cancer prevention is offered by the Greek health care system to the population on an opportunistic basis. This means that screening depends on advice from primary care providers and on individuals' request for screening, since a centralized invitational register is lacking. In planning preventive services, an accurate identification of baseline levels of performance for preventive activities is fundamental, so that realistic goals can be set. METHODS: 366 primary care physicians (39.3% response rate) from nine Greek provinces were surveyed by means of a self-reporting questionnaire of prescription habits. Physicians' screening behaviors and screening recommendations were analyzed for both cost-effective and non-recommended tests during usual check-up visits and targeted cancer screening activities were analyzed. RESULTS: A wide variety of recommendation habits were observed among primary care physicians. With the exception of PAP test, cost-effective tests were advised at sub-optimal rates, with colorectal cancer screening being much less than desirable. Moreover, non-recommended tests were frequently advised. CONCLUSION: Screening tests are performed sporadically and an overall understanding of primary care prevention is lacking. More focused educational interventions must be implemented if primary care is to make an impact on cancer mortality.

Responsibilities in cancer preventive care in Greece. A physicians' survey.

BACKGROUND: Colorectal cancer is the second leading cause of cancer death in European countries. Differences in screening implementation may explain USA vs. European survival differences. The proportion of European primary care physicians advising colorectal screening has been reported to be inconsistent. We therefore hypothesised the presence of a belief-related bias among European physicians regarding who is responsible for cancer screening delivery. OBJECTIVES: To index beliefs in cancer screening implementation among a wide sample of Greek physicians. Study design Cross-sectional survey. METHODS: Three hundred and sixty-six physicians involved in primary care activities in 15 provinces answered a questionnaire about responsibility in cancer screening delivery. Results 22.4% and 7.6% of physicians declared that the health system and the patients, respectively, have the main responsibility for cancer screening implementation, while 70 % advocated patient-health system co-responsibility. Beliefs were statistically correlated to age (p=0.039) and specialisation category (p=0.002). Patients' will was mainly indicated by internists, trainee internists and physicians older than 30, while GPs, trainee GPs and house officers were mainly health system-oriented. Worryingly, when physicians were asked about which specialty should inform the population, 81% indicated family doctor (for-fee-service) while the involvement of free-from-fee specialities was inconsistent. CONCLUSION: A considerable disorientation about responsibilities in cancer screening delivery was observed in our study sample. Continual medical education and clear redefinition of primary care physicians' activities are required.