Do As I Say Not As I Do

Why don't physicians follow their own advice when it comes to cancer screening?

Welcome to March everyone!  As many of you know, March is Colorectal Cancer Awareness Month and a great time to contact your doctor about scheduling a screening test for colorectal cancer.

Most physicians recommend a colonoscopy but there are several other non-invasive tests that are approved for screening.  Due to the rise in colorectal cancers in younger people, several groups recommend beginning colorectal cancer screening at age 45.

To find out more about colorectal cancer screening, I recommend this post, this video and obviously talking to your doctor.

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Recently, I was talking to a couple of physician friends who sheepishly admitted that they had not scheduled their colonoscopies.  I was floored. Both were aware of recommended screening tests, knew GI doctors personally, and had taken care of patients with colorectal cancer.

After talking to me, they also knew that colorectal cancer is the fourth most common cancer in the US and the second leading cause of cancer death.

I also made sure that they knew that screening for colorectal cancer is cost effective and saves lives.

As I walked away, I wondered why were they hesitant to get screened?

And if two physicians that I knew weren’t getting screened, how many other physicians were out there? Is this a thing?

I started with a literature search for studies looking at how physicians take care of themselves.

First, there isn’t much research out there on the health behaviors of doctors. I found some on exercise, alcohol and tobacco use, cholesterol checks and blood pressure screening but not many studies looking at our uptake of recommended cancer screening tests. The studies I was able to find were old and the results surprised me.

Hint: We are normally a very obedient bunch, but when it comes to screening tests a significant portion of doctors are in the “do as I say not as I do” camp.

A large prospective trial called the Women Physicians’ Health Study tracked the health habits of female doctors.  In this sample, researchers found that women physicians were more likely to have undergone recommended cancer screening tests than the general population although less likely to have undergone a recent Pap smear or clinical breast exam than other women of high socioeconomic status.

But before we give ourselves too many pats on the back, eight percent of female physicians over the age of 40 had never had a screening mammogram compared to just 4% of matched peers. And almost sixty percent of women physicians over fifty had never had a colonoscopy. That’s astounding even if it is lower than national averages.

I couldn’t find a follow up paper describing interventions to address these deficiencies.

From a patient standpoint, you may be thinking, “What do I care? I’ve got myself to worry about!” I hear you!

However, evidence suggests that physicians take better care of their patients if we take care of ourselves. Not only by preventing days lost due to illness or death of a beloved physician, but also because, I believe, our personal health behaviors can impact our recommendations for patients.

This beautiful study out of Canada gathered a list of 11K physicians. They found that a third of physicians were overdue for colorectal cancer screening.  🤯A THIRD!

Physicians were more likely than the general population to choose colonoscopy for screening than other methods by almost 6:1, perhaps indicating a belief that this test was superior or that physicians had easier access to this procedure.

The dataset also allowed researchers to look into how physician preference impacted their patients. Turns out that patients whose physicians who were up to date on screening were more likely to complete colorectal screening AND more likely to have the same screening test as their doctor.

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As a woman who has finally admitted to being in her forties, I often share with patients my experience of getting a mammogram and posted my colonoscopy on Instagram.  Neither were fun, but I believe in controlling as much as I can about my cancer risk including early detection if possible. I also know the exponential increase in toxicities of cancer treatment between early stage and more advanced stage cancers. Anything I can do to try to find cancer early, I’m in!

So, my birthday is next week and the only gift I am requesting is that you schedule your recommended screening tests. And maybe ask your doctor if she has done the same.

On my mind…