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PubMed1999

Recommendations on population screening for colorectal cancer in New Zealand. Members of the National Health Committee Working Party on Population Screening for Colorectal Cancer.

The National Advisory Committee on Health and Disability invited a working party to make recommendations on population screening for colorectal cancer in New Zealand. Recent results from randomised controlled trials of screening with guaiac faecal occult blood tests have provided evidence that population screening could reduce mortality from colorectal cancer. However, given the modest potential level of benefit, the considerable commitment of health sector resources, and the small but real potential for harm, the working party does not recommend population screening for colorectal cancer with faecal occult blood tests in New Zealand. The working party does nto recommend pilot colorectal cancer screening programmes in New Zealand because pilot programmes cannot address the issues of concern: the modest potential benefit and the small, but real, potential for harm. The working party does not recommend faecal occult blood testing as a screening test for colorectal cancer in average-risk individuals outside a population screening programme. Those requesting screening by faecal occult blood test should be given information about the potential risks and benefits. Follow-up bowel investigations in the public health system cannot be guaranteed without an increased allocation of resources. As there is yet no evidence from randomised controlled trials that screening with flexible sigmoidoscopy, colonoscopy or double-contrast barium enema produces a reduction in colorectal cancer mortality, the working party does not recommend population screening with these modalities. Wider consultation and further consideration should be undertaken to develop appropriate advice on surveillance recommendations for groups identified to be at increased risk of colorectal cancer. These decisions should be reviewed as evidence of benefit from new types of faecal occult blood test and other screening modalities becomes available. The working party recognises that colorectal cancer is an important cause of morbidity and mortality and recommends that New Zealand participate in international research in this area.

Colonoscopy↗

PubMed1999

The pharmacy screening project--an evaluation of pharmacy-based screening programmes.

OBJECTIVES: The purpose of this study was to establish the proportion of pharmacies providing screening tests in the areas of Pretoria, Potchefstroom and Klerksdorp, the types of tests used and their cost to patients, the criteria employed to select high-prevalence groups, the attitudes of pharmacists towards screening, and their knowledge of test characteristics. SETTING: In Pretoria, 155 pharmacies were randomly selected and all 43 pharmacies in Potchefstroom and Klerksdorp were included. METHODS: The pharmacies included in the study sample were first contacted by telephone to identify those providing screening tests. Pharmacies that provided screening tests and agreed to participate in this study were then visited and a questionnaire was administered. RESULTS: 57% of the pharmacies provided at least one type of screening test. Blood pressure measurement, serum cholesterol, capillary glucose and pregnancy testing were the most common screening tests available. With the exception of blood pressure measurement, the screening tests were conducted less than 5 times per week. All respondents referred clients with abnormal results to general practitioners but only 35% of pharmacies kept records of the patients tested and the test results. The knowledge of pharmacists concerning the important features of screening tests, such as false-positive and false-negative rates, was poor. No quality control procedures for the screening tests were employed. CONCLUSIONS: Providing pharmacists with specific training in the application and interpretation of screening procedures, and implementing quality control measures will reduce the number of false referrals or non-referrals, and will improve the quality of the service. If pharmacies are to play a meaningful role in screening for disease, coverage of the population will need to be increased substantially.

Adult↗

PubMed2004

New Mexico's capacity for increasing the prevalence of colorectal cancer screening with screening colonoscopies.

INTRODUCTION: Colorectal cancer screening rates are low throughout the United States. Colonoscopy has been recommended as a cost-effective strategy for colorectal cancer screening and prevention. We evaluated New Mexico's capacity to increase the prevalence of colorectal cancer screening using colonoscopy. METHODS: We identified New Mexican gastroenterologists from state licensing data and from endoscopic manufacturers. We surveyed gastroenterologists on their weekly number of colonoscopies, capacity for additional screening colonoscopies, and barriers to increasing capacity. We used census data, published data on the yield of screening colonoscopy, and professional society guidelines for cancer/polyp surveillance to estimate the additional colonoscopies required to increase the state's prevalence of endoscopic screening. RESULTS: Forty gastroenterologists, representing all 11 group practices in the state, and nine of 12 solo practitioners responded. They estimated that their weekly procedure capacity could be increased by 41%, from 832 to 1174 colonoscopies. We estimated an annual capacity increase of 14,880 procedures, which could increase the prevalence of endoscopic colorectal cancer screening from the current 35% to about 50% over five years. Lack of support staff, space, and physicians were barriers to increasing screening. CONCLUSION: Implementing a screening colonoscopy strategy could achieve the goal of a higher level of colorectal screening. However, achieving more universal screening would require additional testing modalities.

Colonoscopy↗

PubMed2005

High-risk neonatal hearing screening program using automated screening device performed by trained nursing personnel at Siriraj Hospital: yield and feasibility.

OBJECTIVES: To determine the prevalence and significant risk factors for pathologic hearing screening test results in high-risk neonates and the feasibility of implementing hearing screening program using automated otoacoustic emission (OAE)/ auditory brain stem response (ABR) device performed by trained nursing staffs. STUDY DESIGN: Single-center prospective, descriptive study. MATERIAL AND METHOD: All neonates admitted to the Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, who met the high-risk criteria according to Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, were screened with one-step protocol using an automated OAE/ABR device (AccuScreen, GN Otometrics, Denmark). Infants who failed 2 consecutive OAE tests were reconfirmed by ABR prior to discharge. Descriptive analysis was used for the prevalence of pathologic hearing test results, age at screening, duration of procedure, number of risk factors per infant. Univariate analysis using Chi-square test and multiple logistic regression analysis were used for identification of significant risk factors. RESULTS: Five hundred and seven infants were identified to be at-risk in an 18-month study period. The prevalence of pathologic hearing screening test was 6.7% with unilateral and bilateral pathologic results in 13 and 21 infants (2.6% and 4.1%). Only craniofacial anomalies and mechanical ventilation > 5 days were shown to be independent significant risk factors (42-fold and 4-fold increased risk). Median age at screening test performed was 19 days (range 1-149 days) and almost all infants (97.3%) were screened within 3-month postnatal age. The mean time for hearing screening procedure was 10.7 +/- 8.0 minutes (range 2-60 minutes), 98.1% of procedure was accomplished within 30 minutes. CONCLUSION: Hearing screening using automated OAE/ABR devices in high-risk neonates revealed approximately 7% of pathologic results with almost two-thirds having bilateral affected. The significant independent risk factors in this study population were craniofacial anomalies and mechnical ventilation > 5 days. The protocol of having trained nursing staffs to perform the screening yielded good results, i.e., the coverage of screened infants within 3 months of age (97%), feasible duration of procedure.

Chi-Square Distribution↗

PubMed1990

Advances in vision and eye screening: screening at six months of age.

Eye and vision screening is a prototype preventative health measure. Increased knowledge of eye diseases in children and their treatment mandates much earlier screening than was recommended in the past. Advances in testing permit both the adoption of simpler and faster routine techniques and the application of more sophisticated and accurate screening methods. A thorough vision/eye screening at 6 months of age has been added to the previous examination schedule which only required screening at birth and again at 3.5-4 years of age. The simple scrutiny of the red fundus reflexes in the pupil with a direct ophthalmoscope (Brückner test) provides superior screening for vision, binocular alignment and pathology in infants. The difficult-to-master cover test and its variants can be abandoned for screening purposes. In screening preverbal children, simple optotype charts (HOTV) are proving more efficient than the traditional 'tumbling E' game. Color vision testing should be added to the preschool examination. Vision screening in infants can be enhanced where resources permit by using new preferential looking tests and by employing sophisticated electrophysiological testing. Photographic screening methods based on the red reflex hold considerable promise for more efficient screening of children.

Child↗

PubMed1998

[Screening of cancer of the prostate (IV). Economic approach: the costs of screening tests and treatment. Members of the Sub-Committee of the Prostate of CCAFU].

OBJECTIVES: To estimate the unit and global costs of prostatic cancer screening and the resulting treatments, based on a theoretical screening protocol and the epidemiological data available in France. METHODS: The screening protocol consisted of digital rectal examination (DRE) performed by the general practitioner and serum prostate specific antigen (PSA) assay, with confirmation of the diagnosis by systematized ultrasound-guided biopsies performed by a specialist. Costs were calculated on the basis of the French National Health rating. Treatment costs were estimated on the basis of real public and private establishment case files. Extrapolations to the general population were based on two estimations of the screening yield. RESULTS: The theoretical cost of screening was estimated to be 501 French Francs (FF) per person screened and 16,700 or 91,000 FF per cancer detected, depending on the detection rate adopted. The mean cost of curative treatment was estimated to be 44,000 FF per cancer. The theoretical global cost of screening and treatment was estimated to be between 4 and more than 10 billion French Francs. CONCLUSION: Unit costs per individual of screening and treatment of prostatic cancer may appear acceptable. The biases of economic calculations related to extrapolations to the general population and uncertainties concerning the public health benefits of organized screening compared to the current situation of individual screening explain the current predominant attitude of non-recommendation of organized screening.

Aged↗

PubMed2004

[Breast cancer screening and repeat screening].

PURPOSE: This study was to investigate the characteristics and related factors of breast cancer screening and repeat screening, and to propose nursing interventions to increase the rate of breast cancer screening and repeat screening. METHOD: Study subjects was 236 women residing in the community, teachers and nurses who were older than 45 were recruited. Data was collected with self administered questionnaires from July 1st to August 31st, 2003 and analysed using SPSS/WIN 10.0 with X(2)test, t-test, and stepwise multiple logistic regression at a significant level of =.05. RESULT: The breast cancer screening rate was 57.2%, and repeat screening rate was 15.3%. With the multiple logistic regression analysis, factors associated with mammography screening were age and perceived barriers of action, and factors related to the repeat mammography screening were education level and other cancer screening experience. CONCLUSION: Based on the results, we recommend the development of an intervention program to decrease the perceived barrier of action, to regard mammography as an essential test in regular check-up, and to give active advertisement and education to the public to improve the rates of breast cancer screening and repeat screening.

Breast Neoplasms↗

PubMed2001

[Tuberculosis screening coverage of immigrants: marked attrition in follow-up screenings].

OBJECTIVE: To estimate the coverage of bi-annual follow-up screening for tuberculosis amongst immigrants, excluding asylum seekers. DESIGN: Retrospective cohort study. METHODS: Participation in bi-annual chest X-ray screening during the first 18 months was recorded for immigrants who underwent entry screening in 1996 in the following Dutch municipal health services (MHS's): Zuid-Kennemerland (Haarlem), Flevoland (Lelystad), Midden-Brabant (Tilburg) en West-Friesland (Hoorn). The number of immigrants that had left the country before the subsequent screening was taken into account in the Zuid-Kennemerland MHS data on screening coverage. RESULTS: Of the 2147 immigrants who underwent entry screening in 1996 (48% men and 52% women; 68% aged 15-34 years), 1075 (50%; range: 29-76) returned for the first follow-up screening and 620 (29%; 21-61) returned for the second. In MHS Zuid-Kennemerland, 113 of the 777 immigrants who had a chest X-ray at entry had left the country before the first follow-up screening, and another 89 had left before the second. Of the remaining persons, who were probably still in the Netherlands, 454 (68%; 454/777 = 58%) returned for the first follow-up screening, and 166 (29%; 166/777 = 21%) returned for the second. CONCLUSION: The coverage of screening for tuberculosis in immigrants decreased after the obligatory entry screening, even when corrected for those who left the country.

Adolescent↗

PubMed2002

National screening policies in general practice: a case study of routine screening for partner abuse.

Internationally-recognised criteria for screening for a particular disorder require the following: availability of a clear diagnosis; a suitable validated screening test; acceptability of routine screening by patients and health providers; benefits of earlier detection and application of appropriate interventions to prevent the progression of a disorder, and hence reduction in incidence of morbidity and mortality; identification of possible harm from screening (false positives, false negatives, adverse effects of labelling, early diagnosis or unnecessary treatment of persons with true-positive test results with inconsequential disease) and weighing this against potential benefits; identification of possible sub-populations with the possibility of targeted screening of high-risk populations; good quality evidence of interventions effective in preventing or managing the disorder; and a cost-effectiveness assay. The New Zealand Ministry of Health have launched a best-practice guideline recommending all female general practice patients sixteen years and over be routinely screened for physical and sexual abuse by their partners. Inter-partner violence, especially against women by male partners and expartners, is a serious public health problem. However, review of existing research indicates that this guideline meets none of the criteria listed above. Considerable funding is invested in training health providers to implement this screening protocol, but, in the absence of effectiveness studies, cost-effectiveness cannot be assessed. Under current conditions, routine screening of adult women for partner abuse cannot be justified. However, GPs should be encouraged to learn about partner abuse and consider this possibility in patients presenting with physical injuries, psychological disturbance or social dysfunction, especially in high-risk patients. Research should be supported for the development and validation of effective, acceptable screening tools and randomised controlled trials of appropriate interventions. The desire to intervene for the public good should not dictate the implementation of a screening programme that disregards accepted screening criteria.

Adolescent↗

PubMed1993

Screening for lung cancer re-examined. A reinterpretation of the Mayo Lung Project randomized trial on lung cancer screening.

In the 1970s, three randomized trials, each involving approximately 10,000 male subjects, were carried out to determine the value of lung cancer screening in cigarette smokers. These studies have been widely interpreted as providing strong evidence that screening does not contribute to decreased death rates, and, accordingly, the American Cancer Society firmly recommends against lung cancer screening. No randomized trial, however, has evaluated screening for lung cancer in women, who currently comprise 39% of the lung cancer population. The trials performed at Memorial-Sloan Kettering and at Johns Hopkins were designed so that subjects were randomized to either a single screen (annual chest x-ray alone) or a dual screen (annual chest x-ray and every-4-month sputum cytology) group. While the results of both revealed no difference in mortality between the groups, these studies were designed to examine the value of sputum cytology, and no conclusion regarding the efficacy of chest x-rays can be inferred. In the Mayo Lung Project, patients were randomized to a screened group in which a chest x-ray and sputum cytology were obtained every 4 months or to a control group in which an annual chest x-ray and cytology were simply recommended. The results indicate that after 6 years, more lung cancers were detected among the 4,618 men in the screened group (206 cases, 4.46%) than in the 4,593 men in the control group (160 cases, 3.48%). The screened group showed a superiority over the control subjects in resectability rate (46% vs 32%) and 5-year survival (33% vs 15%). However, the number of cancer deaths was slightly greater in the screened (122) than in the control group (115), and, consequently, the mortality rates were not significantly different among the groups. An "overdiagnosis bias" has been suggested to account for the increased number of lung cancers detected in the screened vs the control population in the Mayo Lung Project. This explanation is statistically plausible, but, given the status of lung cancer as the most lethal of malignancies, is biologically unlikely. An alternative hypothesis is that chance alone might have accounted for the observed 0.98% difference in lung cancer detection rates. Were this the case, then 46 additional cases would have been detected in the control group had this chance event not occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2001

A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. 1977.

South-East London Screening Study Group (Department of Community Medicine, St Thomas's Hospital and Medical School, London SE1 1EH, England). A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. International Journal of Epidemiology 1977;6:357-63. The results of a controlled trial of multiphasic screening in general practice are presented. In 1967, 7229 individuals aged between 40 and 64 years were randomly allocated into either a Screening or Control group. The Screening group were invited to attend two screening sessions held about two years apart, while the Control group continued to receive conventional medical care. Both groups were then invited to undergo a health survey in 1972-73 which revealed no significant differences in morbidity between the two groups. Careful follow-up permitted detailed Screening-Control comparisons of various outcome measures-consultation and hospital admission rates, certified sickness absence from work, and mortality. Nine years after the initial screening, no significant differences were found between the two groups in any of the outcome measures. It is estimated that a similar screening programme for the entire middle-aged UK population would cost 142 million pounds at 1976 prices.

Adult↗

PubMed2004

Screening for abdominal aortic aneurysms: the effects of age and social deprivation on screening uptake, prevalence and attendance at follow-up in the MASS trial.

UNLABELLED: OBJECTIVES/SETTING: The effectiveness of screening programmes may be improved by knowledge of factors affecting screening uptake, disease prevalence and attendance for follow-up. Data from the Multicentre Aneurysm Screening Study (MASS) are used to examine the influences of age and social deprivation in the context of screening for abdominal aortic aneurysms (AAAs). METHODS: In the MASS trial, a population-based sample of 34,000 men aged 65 to 74 received an invitation to screening. The associations of attendance at screening with age, social deprivation and season of the year when invited to attend were investigated using logistic regression analysis. Similar analyses were performed for AAA prevalence and attendance at recall scans. RESULTS: Compared with men aged 65-69, those aged 70-74 were less likely to attend screening (79% vs 81%), had increased prevalence of AAA (6% vs 4%) and were less likely to attend for follow-up (79% vs 84%). Compared with those in the least deprived quartile, those in the most deprived quartile also were less likely to attend (75% vs 85%), had increased prevalence (6% vs 4%) and were less likely to attend for follow-up (80% vs 83%). Season showed no significant association with attendance at initial screening. CONCLUSIONS: Higher age and social deprivation are associated with both poorer attendance at screening and follow-up, and having an AAA. This highlights the importance of promoting screening programmes, particularly to the more deprived populations.

Aged↗

PubMed1991

Different genomic and metabolic patterns between mass screening-positive and mass screening-negative later-presenting neuroblastomas.

The mass screening of neuroblastoma has been undertaken in Japan by measuring urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) in all infants at the age of 6 months. This program may not only improve the prognosis but also provide important insights into the biology and evolution of human neuroblastoma. The authors studied and discuss the clinical significance of the N-myc oncogene, catecholamine metabolism, and other tumor markers in 43 patients with neuroblastoma who underwent the urinary screening test at 6 months of age. Thirty patients were found by the screening, and 13 were negative at the screening but later had a tumor. In the former group, the tumors were mostly in early stages (Stage I, 12; Stage II, 11; Stage III, seven), no amplification of N-myc was observed, and all patients are alive without disease. Although two patients whose urine at the screening showed elevated VMA and HVA levels and accidentally were not treated for 13 and 17 months, there was no change in the values of VMA and HVA during that time. However, in the latter group, the tumors were mostly in advanced stages (Stage I, one; Stage III, four; Stage IV, eight) and N-myc amplification was observed in seven of 13. Only two of these 13 are alive without disease. The age at diagnosis of the screening-negative group was 23 months compared with 8 months in the patients identified by screening, and the pattern of catecholamine metabolites in the screening-negative group tended to be dopaminergic with a low VMA-HVA ratio, especially in cases with N-myc amplification. These data suggest that the screening-positive patients with neuroblastoma may have favorable characteristics, and the biology of these tumors may be different from that of screening-negative later-presenting tumors. They also suggest that there may be at least two distinct subsets of neuroblastoma. For the early detection of the poor prognostic neuroblastomas, the measurement of urinary dopamine with VMA and HVA at later ages, such as 1 to 2 years, should be considered.

Adrenal Gland Neoplasms↗

PubMed2005

Universal neonatal hearing screening versus selective screening as part of the management of childhood deafness.

BACKGROUND: The principal factors that decide how deafness affects a child's development are the degree of hearing impairment and the age at which it is diagnosed. A number of factors are thought to increase the risk of hearing impairment: low birth weight, prematurity, perinatal hypoxia and jaundice, among others. The high incidence of deafness in children without risk factors and the introduction of simple new screening tests of high sensitivity and specificity has led many prestigious bodies to recommend universal early detection programmes for deafness rather than screening targeted only at high-risk groups. OBJECTIVES: To compare the long-term effectiveness of a universal neonatal screening and early treatment programme for hearing impairment with: a) screening and treatment only of high-risk neonates and b) opportunistic screening and treatment. SEARCH STRATEGY: Databases searched were MEDLINE (1966 to 2003), EMBASE (1974 to 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004) and registers of health technology assessment agencies as well as registers of clinical guidelines. SELECTION CRITERIA: Randomised controlled trials comparing universal neonatal screening with either high-risk screening or opportunistic screening for hearing impairment. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results to identify suitable trials. MAIN RESULTS: No studies were identified which fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: The long-term effectiveness of universal newborn hearing screening programmes has not been established to date. There is a need for controlled trials and before and after studies to address this issue further.

Deafness↗

PubMed2007

Who gets screened, and where: a comparison of organised and opportunistic mammography screening in Geneva, Switzerland.

It is unclear whether introducing organised mammography screening programmes in a population where opportunistic screening is prevalent results in the two types of screening mainly competing against each other or attracting different groups of women. To compare women who participate in organised screening and those who prefer opportunistic screening, we conducted a prospective study of 932 women followed for 8 months after an invitation to participate in the first round of an organised screening programme in Geneva, Switzerland. All women were aged 50-69 years and were due for a mammogram according to local guideline. Of the 932 participants, 11.6% had an organised and 39.4% an opportunistic mammogram during follow-up. Women who were in the stage of contemplation, had favourable attitude toward mammography screening, and perceived their risk of breast cancer to be high were more likely to have a mammogram (either organised or opportunistic). Compared to women who had an opportunistic mammogram, women with an organised mammogram were less positive about screening, less likely to be in maintenance at baseline (adjusted odds ratio (OR), 3.0; 95% confidence interval (CI), 1.7-5.5), to have a history of benign breast disease (OR, 2.4; 95% CI, 1.2-5.1) and to perceive their financial situation as comfortable (OR, 1.7; 95% CI, 1.1-2.8). Although screening uptake was low, the programme appeared to attract women in lower socio-economic strata who did not usually undergo mammography screening.

Aged↗

PubMed2005

Hearing ability according to screening at conscription; comparison with earlier reports and with previous screening results for individuals without known ear disease.

OBJECTIVE: (1) To study if young, Swedish men have poorer or better hearing according to screening at conscription in 1988 compared to 1969-1977. (2) To study how the results of screening and audiometry vary across the teenage years for a group of boys without middle ear disease. METHOD: A birth cohort has earlier been well documented regarding results in four general screenings with follow-up and examinations and treatment for middle ear disease at the ENT departments in the area. Their results when screened at conscription have been compared with those in earlier reports on screening of Swedish conscripts. We have also studied results in screenings and follow-up at 11 and 14 years of age with special focus on small losses at the frequencies of 3, 4, 6 and 8 kHz and describe how 611 boys without known ear disease performed in these examinations and in screening at the age of 18. RESULTS: There is no obvious trend in the prevalence of hearing loss in Swedish conscripts. At 11 years of age 80.4% and at 14 years of age 64.6% of small high tone losses diagnosed by screening were not confirmed by audiometry. Approximately half of those who had confirmed losses had normal screening at conscription. CONCLUSIONS: 18-year-old Swedish boys did not have poorer hearing in 1998 than 29 years earlier. Information drawn from screenings must be interpreted with caution.

Adolescent↗

PubMed2005

Policy issues for expanding newborn screening programs: the cystic fibrosis newborn screening experience in the United States.

OBJECTIVE: To describe the screening approaches and implementation strategies for cystic fibrosis newborn screening in the 12 programs that were offered in 11 states in 2002. STUDY DESIGN: Telephone interviews conducted in the spring of 2003 with program representatives in the 11 states. Screening approaches were defined in four overlapping categories: state mandated screening, state-wide offering, hospital based screening, and screening with informed consent. RESULTS: Screening was state mandated in seven states but was routinely offered to most infants in nine states. The primary care provider or hospital determined if screening was done in three states (four programs). Informed consent was explicitly documented in two states. In five programs, immunoreactive trypsinogen exclusively was used to identify at-risk infants. In seven programs, a second tier DNA test was also used, but these programs each had distinct strategies. In only two programs where DNA testing was performed and normal sweat tests indicated carrier status, were results routinely provided to parents "in person" at a CF center. CONCLUSION: The diversity of approaches for screening approaches and strategies has advantages for future policy decisions, provided that data about the clinical and psychosocial impact of screening from these programs are collected and disseminated. As additional states determine that the resources are available, programs can be designed with a more favorable benefit/risk balance as a result of the successes and challenges faced by other states.

Cystic Fibrosis↗

PubMed2004

To screen or not to screen, when clinical guidelines disagree: primary care physicians' use of the PSA test.

BACKGROUND: Clinical guidelines for using the prostate-specific antigen (PSA) test as a population-based screening tool vary considerably. This study qualitatively explored primary care physicians' PSA screening practices and their understanding of the PSA screening controversy. METHODS: Fourteen telephone focus groups were conducted with 75 primary care physicians practicing in 35 US states. Data were coded around three major topics: PSA screening practices, factors influencing these practices, and familiarity with clinical guidelines. RESULTS: Two practice patterns emerged. Most participants recommended regular PSA screening beginning around age 50 for asymptomatic men with no known risk factors and at least a 10-year life expectancy. These "routine screeners" attributed their approach to experience that supported the benefit of PSA screening and to patient demand for the test. Other physicians discussed the implications of PSA screening with patients before offering the test, but neither recommended for or against it. The approach of these "nonroutine screeners" was primarily guided by the lack of scientific evidence documenting the benefit of PSA screening. CONCLUSIONS: The observed practice patterns reflect both sides of the PSA screening controversy. While routine and nonroutine screeners differ in their approach, both reported high rates of PSA screening.

Aged↗