Role of healthcare professionals in cancer screening

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2020-12, Vol.26 (6), p.546-548
• Main Authors: Tsang, E W Y, Chan, M C M, Chan, L H L, Chan, J P H, Lee, S L, Tsui, M F
• Format: Article
• Language: English
• Subjects: Asymptomatic; Breast cancer; Colonoscopy; Colorectal cancer; Compliance; Family physicians; Health care policy; Mammography; Medical screening; Mortality; Participation; Patient education; Physicians; Population; Professionals; Prostate; Roles; Womens health
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj209148

Frontline healthcare professionals, in particular general practitioners (GPs) and community pharmacists, are in a position to identify eligible individuals, as they act as first point of contact for the general population in the community. Because GPs may understand patients' social histories, personalities and attitudes in addition to their physical health conditions and demographics, they can advise their patients as “trusted advisors”.15 A thorough face-to-face explanation of screening and its procedures by healthcare professionals enhances patients' willingness to opt in for screening. For CRC screening, a local study concluded that patients with regret over their initial screening choice were associated with poorer screening compliance,18 while a low compliance also stems from limited knowledge of benefits and risks of the screening modalities available.19 Increasing evidence also shows higher patient participation and screening adherence with the offer of choice for different screening modalities, with an odds ratio of 2.54 (95% confidence interval=2.30-2.82, P[lesser than]0.001).20Current modalities of breast cancer screening include mammography and magnetic resonance imaging, as well as patient self-examination. Some documented problems in CRC screening include positive faecal occult blood test results without follow-up and colonoscopy that is unable to reach the cecum or detect important lesions.22Withdrawal time and adenoma detection rate are important quality indicators for CRC screening.23To mitigate inconsistencies in international breast cancer screening guidelines, local quality assurance standards should be established for the existing mammography service in Hong Kong. There are multiple methods by which physicians could monitor patients' situation after the first round of screening, for instance through the alert system in patients' electronic medical records during the follow-up period.27 In addition, interactive training seminars on achieving shared decisionmaking could be held to boost physicians' intention to prescribe faecal immunohistochemical test and colonoscopy.28 Patients could also be reminded to take part in cancer screening via automated patient-directed telephone calls which have been demonstrated to be significant in enhancing CRC screening uptake.29 A non-adherence model could be established by combining six parameters, including sex, history of psychiatric illness, non-adherence ratio, wait time, number of prior missed end