Physicians’ and Patients’ Knowledge

Accessible online at: www.karger.com/ort Fax +49 761 4 52 07 14 [email protected] www.karger.com Physicians’ and Patients’ Knowledge of Cancer Screening – A Wake-Up Call A study that surveyed 65 German physicians yielded no better results [7]. 76% thought that the 5-year survival rate demonstrated the benefit of screening, and only 1 of the 65 physicians was in a position to adequately explain lead-time bias. The evaluation of consultations by 20 gynecologists to provide basic information on mammography screening produced the following problematic results [8]: When questioned on the risk of a 55-year-old woman of actually having breast cancer, the gynecologists responded either with qualitative information (i.e. breast cancer is the most common form of cancer) or with lifetime incidence. For the most part, they expressed the information qualitatively and not numerically. Only 1 gynecologist named all-cause mortality as a criterion for benefit. The disease-specific benefit was communicated mainly as a relative risk reduction, a measure that does not reflect the actual benefit [9]. Information on the risks was consistently incomplete. No gynecologist addressed the problem of overdiagnosis and overtreatment [10]. In the rare cases in which quantitative information was communicated, the established standards for risk communication were not applied. The trend towards a one-sided emphasis on the benefit and neglect of the risks became clear in a study involving 34 Austrian general physicians and internists. When providing information on the prostate-specific antigen (PSA) test, the physicians rarely discussed the risks and potential damage. A portion of the doctors said that they saw no sense in confusing the patients, but they may not actually have had the required knowledge at hand [11]. These studies leave no doubt that many doctors are not in a position to inform their patients adequately of the benefits and harms of cancer screening.