Colorectal cancer. A blueprint for disease control through screening by primary care physicians
H. J. Wanebo, W. L. Fang, A. S. Mills and A. M. Zfass
The Virginia Colorectal Cancer Control Project is a statewide effort to
reduce morbidity and mortality from colorectal cancer by stimulating the
adoption of screening and early detection practices by primary care
physicians. The project emphasizes use of the three-day fecal occult blood
test, digital rectal examination, and endoscopy. Recruitment strategies
included personal contact, newsletters, journal articles, and screening
workshops. Of the 33 318 patients screened over 26 months, positive fecal
occult blood test reactions were recorded in 3.3% of asymptomatic patients
and in 14.8% of symptomatic patients. Polyps were found in 149 and cancer
was diagnosed in 94 patients of whom one third were asymptomatic. Eighty
percent of the latter had Dukes' A and B lesions, 12% had Dukes' C lesions,
and 8% had Dukes' D lesions. In contrast, only 36% of the symptomatic
cancers were Dukes' A and B lesions, and 69% were Dukes' C and D lesions.
These results suggest that primary care physicians can be effective in the
screening and detection of precancerous polyps and early-staged colorectal
cancers.
