Providers’ Knowledge, Attitudes, and Practices Related to Colorectal Cancer in Brazil

In Brazil, colorectal cancer is the fourth most common cause of cancer-related death among men, and the third most common among women. Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best.

In Brazil, three tests can be used to screen for colorectal cancer: colonoscopy, fecal occult blood test (FOBT), and flexible sigmoidoscopy. Since 2002, the Brazilian National Cancer Institute (INCA) has recommended an annual FOBT for people who are 50 years old or older and have no symptoms, and a follow-up colonoscopy in case of a positive screening test. But little was known about how often these recommendations were followed.

This study aimed to understand colorectal cancer screening knowledge, attitudes, and practices of providers in the Brazilian network of primary health care units.

How the Study Was Done

In 2011, 1,600 health units were selected randomly from all regions of Brazil. One coordinator and one doctor or nurse from each health unit was asked to participate in a telephone survey about colorectal cancer screening. In total, 1,251 coordinators, 182 doctors, and 347 nurses answered the survey.

Key Findings

Unit Coordinator Survey

About half of coordinators said they knew about INCA cancer screening recommendations. Of these, 90% said their health unit followed the recommendations.
Coordinators reported that 25% of units were leading screening outreach activities.
Coordinators reported that FOBT was used in 50% of the health units, while colonoscopy was used in 26% and sigmoidoscopy in 17%.

Provider Survey

40% of doctors and 37% of nurses considered INCA recommendations for colorectal cancer screening very influential.
Almost all doctors and nurses consider colonoscopy an effective test (94% and 97%, respectively), while fewer consider flexible sigmoidoscopy (82% and 92%, respectively) and FOBT (56% and 75%, respectively) effective colorectal cancer screening tests.
Nearly half (47%) of doctors and nearly two-thirds (65%) of nurses said they did not conduct colorectal cancer screening. Those who were conducting colorectal cancer screening used FOBT most often, followed by colonoscopy and sigmoidoscopy.
30% of doctors and 14% of nurses reported that they began routine colorectal cancer screening with patients aged 50 to 55 years, as recommended.

Conclusion

Most doctors and nurses in Brazil know colorectal cancer screening saves lives, but almost half of doctors did not offer colorectal cancer screening tests to their patients. This may reflect the low influence of screening recommendations, doctors receiving their medical education when colorectal cancer was not of high concern in Brazil, lack of capacity for colorectal cancer screening in certain parts of the country, and lack of national or local colorectal cancer screening programs.