Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States

Abstract

Background: Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screening tests save lives. Nevertheless, these 2 statistics are often used to promote screening.

Objective: To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives.

Design: Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials.gov registration number: NCT00981019)

Setting: National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate).

Participants: 297 physicians who practiced both inpatient and outpatient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011.

Intervention: Physicians received scenarios about the effect of 2 hypothetical screening tests: The effect was described as improved 5-year survival and increased early detection in one scenario and as decreased cancer mortality and increased incidence in the other.

Measurements: Physicians' recommendation of screening and perception of its benefit in the scenarios and general knowledge of screening statistics.

Results: Primary care physicians were more enthusiastic about the screening test supported by irrelevant evidence (5-year survival increased from 68% to 99%) than about the test supported by relevant evidence (cancer mortality reduced from 2 to 1.6 in 1000 persons). When presented with irrelevant evidence, 69% of physicians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowledge questions about screening statistics, many physicians did not distinguish between irrelevant and relevant screening evidence; 76% versus 81%, respectively, stated that each of these statistics proves that screening saves lives (P = 0.39). About one half (47%) of the physicians incorrectly said that finding more cases of cancer in screened as opposed to unscreened populations "proves that screening saves lives."

Limitation: Physicians' recommendations for screening were based on hypothetical scenarios, not actual practice.

Conclusion: Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evidence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening.

Primary funding source: Harding Center for Risk Literacy, Max Planck Institute for Human Development.