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A Blueprint for Disease Control Through Screening by Primary Care Physicians

Harold J. Wanebo, MD; Wei Li Fang, PhD; A. Scott Mills, MD; Alvin M. Zfass, MD

Arch Surg. 1986;121(11):1347-1352.

Abstract
• 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.

(Arch Surg 1986;121:1347-1352)

Author Affiliations
From the Virginia Colorectal Cancer Control Project, University of Virginia Medical Center, Charlottesville (Drs Wanebo and Fang), and Medical College of Virginia/Virginia Commonwealth University, Richmond (Drs Mills and Zfass).

Footnotes
Accepted for publication Aug 11, 1986.

Read before the 39th Annual Meeting of the Society of Surgical Oncology, Washington, DC, May 14, 1986.

Reprint requests to Box 181, University of Virginia School of Medicine, Charlottesville, VA 22908 (Dr Wanebo).

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