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Colorectal Cancer Screening with Double-Contrast Barium Enema: A National Survey of Diagnostic Radiologists

¹ Health Services and Economics Branch, Applied Research Program, National Cancer Institute, Executive Plaza North, Rm. 4005, 6130 Executive Blvd., Bethesda, MD 20892-7344.
² Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bldg. 10, Rm. 1C-660, Bethesda, MD 20892-1182.
³ Statistical Research and Applications Branch, Surveillance Research Program, National Cancer Institute, Rm. 5047, 6116 Executive Blvd., Bethesda, MD 20892.

OBJECTIVE. This article describes diagnostic radiologists' colorectal cancer screening activities and beliefs about screening effectiveness and future capacity for screening with double-contrast barium enema, and compares radiologists' opinions about colorectal cancer screening with those of primary care physicians.

MATERIALS AND METHODS. We surveyed a nationally representative sample of diagnostic radiologists. Of 381 eligible radiologists, 312 (82%) responded. Descriptive statistics and chi-square tests were used to assess radiologists' opinions about double-contrast barium enema volume and capacity and to compare radiologists' beliefs about colorectal cancer screening with those of primary care physicians. Logistic regression was used to identify characteristics of radiologists who receive referrals for or perform a higher volume of screening double-contrast barium enema and of those who expect the volume of double-contrast barium enemas to increase.

RESULTS. Seventy-five percent of radiologists said that double-contrast barium enema is a "very effective" colorectal cancer screening procedure compared with 33% of primary care physicians. Although 86% of radiologists reported performing one or more screening double-contrast barium enema procedures during a typical month, only 27% indicated that they did so 11 or more times. Fifteen percent of radiologists said that their double-contrast barium enema volume had increased over the past 3 years, and 50% expect an increase over the next 3 years. Only 8% said that the capacity of facilities and personnel to meet the demand for double-contrast barium enemas in their geographic area of practice is inadequate. Geographic region and belief in double-contrast barium enema efficacy were predictors of double-contrast barium enema volume and referrals.

CONCLUSION. Most diagnostic radiologists perform colorectal cancer screening with double-contrast barium enema, but procedure volumes are modest. Because primary care physicians view double-contrast barium enema less positively than do radiologists, radiologists' expectations for an increased volume of double-contrast barium enemas over the next few years may not be realized.

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