Study on Screening Services

in Inner Cities

WASHINGTON, DC -- June 19, 2000 -- Changes in physician behaviors may improve cancer screening and prevention among inner-city residents, suggest the results of a study.

"Inner-city residents receive fewer cancer prevention and screening services than residents of higher-income communities," said study co-author Sherri Sheinfeld Gorin, PhD, of the Joseph L. Mailman School of Public Health of Columbia University.

Dr. Sheinfeld Gorin and colleagues surveyed 122 physicians in three inner-city communities in New York City about their cancer prevention and screening practices and their awareness of American Cancer Society screening guidelines. The researchers also asked physicians about factors that prevented them from providing prevention and screening services.

Although 70 percent of the respondents were familiar with American Cancer Society guidelines for checkups, many were not aware of the guidelines for specific cancer-related tests, the researchers found.

The study results appear in the July issue of the American Journal of Preventive Medicine.

Only 17 percent of the respondents knew that a flexible sigmoidoscopy (a screening test for colorectal cancer) is recommended every five years after the age of 50. Only 5 percent of the respondents knew the pelvic exam and Pap smear are recommended every one-to-three years for women 18-40; and only 2 percent knew that the clinical breast exam is recommended every three years for women 20-39, and annually beginning at age 40.

The researchers also found that the inner-city physicians they surveyed were less likely to provide advice to their patients on quitting smoking and modifying high-fat diets, compared to other physicians surveyed nationally and locally. Also, a significant proportion of physicians suggested lung and prostate cancer screening tests that were inconsistent with national recommendations, according to the study.

The physicians cited four factors as the main barriers affecting their provision of preventive medicine -- inadequate training in preventive medicine, lack of time, offices that were not supportive of prevention, and difficulty with insurance reimbursement.

A number of approaches exist to potentially improve the state of inner-city preventive medicine. "Multi-pronged approaches that spark cognitive, social, and behavioral changes in physicians, including office-based charting systems have shown promise," said Dr. Sheinfeld Gorin. Changes in preventive care financing should also help inner city physicians provide better preventive care.

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