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Muacevic A, Adler JR, Almutairi A, Almadhi F, Alhawshani T, Almishrafi S, Alharbi B. Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia. Cureus 2023; 15:e33829. [PMID: 36819377 PMCID: PMC9930872 DOI: 10.7759/cureus.33829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Cancer screening programs exist in Saudi Arabia for some types of cancers. However, data on primary healthcare center (PHC) physicians' practices in referring patients for screening tests or procedures remain unclear. METHODOLOGY A cross-sectional study was conducted with a self-reported survey that included 141 PHC physicians affiliated with the Ministry of Health in the Al-Qassim region of Saudi Arabia. The primary outcome was the practice of recommending to average-risk patients screening tests for different types of cancers including breast, colorectal, cervical, prostate, and lung, and testing if sociodemographic, specialty, job level, years of experience, a family history of cancer, and patients encountered per day affect their decisions. Secondary outcomes were the barriers perceived by physicians to recommending a screening test. p-value <0.05 was considered significant. RESULTS The study included 141 respondents, of which 60.3% were males, and the mean age of the entire population was 35.7 ± 8.3 years. The rate of recommending cancer screening varied by the type of cancer, with screening for colorectal cancer being the most prominent (64.5%), followed by breast cancer (51.8%). Fear of finding cancer, poor patient compliance, and difficulty in scheduling the test were the most common patient, physician, and system-related barriers as perceived by PHC physicians. Male physicians were less likely to recommend patients for breast (0.10, 95%CI 0.04-0.23, p < 0.001) and cervical (0.26, 95%CI 0.08-0.78, p = 0.017) cancer screening. However, they were 3.74 times more likely to recommend prostate cancer screening (95%CI 1.20-11.68, p = 0.023) and 5.79 times more likely to request lung cancer screening (95%CI 1.27-26.39, p = 0.023). Level of education, specialty, and being a senior physician were factors associated with cervical cancer screening. Physicians who work in non-general practice specialties were more likely to recommend cervical cancer screening than those who work in general practice (95%CI 0.04-0.48, p = 0.002). Senior physicians such as registrars/senior registrars and consultants were more likely to request or recommend a patient for breast cancer screening (2.85, 95%CI 1.11-7.35) and cervical cancer screening (6.35, 95%CI 2.10-019.19). CONCLUSION Screenings for colorectal and breast cancer were the commonly recommended screening tests. Patients' fear of finding cancer, poor patient compliance, and delays or difficulty in scheduling the procedures were the commonly identified barriers as perceived by physicians that influenced physician decisions in referring patients for cancer screening. Our findings suggest that cancer screening rates may be improved by educating individuals on the benefit of early detection of cancers and providing assurance for them with regard to the availability of effective treatments. More research is needed on ways to overcome the obstacles physicians encounter and the outcomes of these measures with regard to improved screening practices.
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Jackson SD, de la Rue MR, Greenslade TPL, John AM, Wahid S, Martin RM, Williams NJ, Turner EL. Screening asymptomatic men for prostate cancer: A comparison of international guidelines on prostate-specific antigen testing. J Med Screen 2022; 29:268-271. [PMID: 36062629 PMCID: PMC9574423 DOI: 10.1177/09691413221119238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarise and compare the key recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer, and so highlight where more evidence is required to facilitate consistent recommendations. METHODS The Medline database and websites of 18 national screening organisations and professional associations were searched between January 2010 and November 2020 to identify screening guidelines published in English, considering recent clinical trials. RESULTS Population-based PSA testing of asymptomatic men is not widely recommended. Guidelines emphasize shared patient-clinician decision making. For 'average-risk' men choosing to be screened, the recommended age varies from 50-55 to 70 years, alongside consideration of life expectancy (ranging from 7-15 years). Screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA. The earliest age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement. CONCLUSIONS Population screening of asymptomatic men is not widely recommended. Instead, balancing the potential harms and benefits of PSA testing is endorsed. Variation between guidelines stems from differing interpretations of key trials and could lead to clinician-dependent screening views. The development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled.
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Affiliation(s)
- Sherena D Jackson
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - May R de la Rue
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Thomas PL Greenslade
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Anna M John
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Shahida Wahid
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Richard M Martin
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Naomi J Williams
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Macdonald C, Mazza D, Hickey M, Hunter M, Keogh LA, Investigators KC, Jones SC, Saunders C, Nesci S, Milne RL, McLachlan SA, Hopper JL, Friedlander ML, Emery J, Phillips KA. Motivators of Inappropriate Ovarian Cancer Screening: A Survey of Women and Their Clinicians. JNCI Cancer Spectr 2021; 5:pkaa110. [PMID: 33554034 PMCID: PMC7853181 DOI: 10.1093/jncics/pkaa110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background This study examined why women and doctors screen for ovarian cancer (OC) contrary to guidelines. Methods Surveys, based on the Theoretical Domains Framework, were sent to women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer and family physicians and gynecologists who organized their screening. Results Of 1264 Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer women, 832 (65.8%) responded. In the past 2 years, 126 (15.1%) had screened. Most of these (n = 101, 80.2%) would continue even if their doctor told them it is ineffective. For women, key OC screening motivators operated in the domains of social role and goals (staying healthy for family, 93.9%), emotion and reinforcement (peace of mind, 93.1%), and beliefs about capabilities (tests are easy to have, 91.9%). Of 531 clinicians 252 (47.5%) responded; a minority (family physicians 45.8%, gynecologists 16.7%) thought OC screening was useful. For gynecologists, the main motivators of OC screening operated in the domains of environmental context (lack of other screening options, 27.6%), and emotion (patient peace of mind, 17.2%; difficulty discontinuing screening, 13.8%). For family physicians,, the strongest motivators were in the domains of social influence (women ask for these tests, 20.7%), goals (a chance these tests will detect cancer early, 16.4%), emotion (patient peace of mind, 13.8%), and environmental context (no other OC screening options, 11.2%). Conclusion Reasons for OC screening are mostly patient driven. Clinician knowledge and practice are discordant. Motivators of OC screening encompass several domains, which could be targeted in interventions to reduce inappropriate OC screening.
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Affiliation(s)
- Courtney Macdonald
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Morgan Hunter
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - kConFab Investigators
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sandra C Jones
- ACU Engagement, Australian Catholic University, Melbourne, Australia
| | | | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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