Colorectal cancer. A blueprint for disease control through screening by primary care physicians

The Virginia Colorectal Cancer Control Project is a statewide effort to reduce morbidity and mortality from colorectal cancer by stimulating the adoption of screening and early detection practices by primary care physicians. The project emphasizes use of the three-day fecal occult blood test, digital rectal examination, and endoscopy. Recruitment strategies included personal contact, newsletters, journal articles, and screening workshops. Of the 33 318 patients screened over 26 months, positive fecal occult blood test reactions were recorded in 3.3% of asymptomatic patients and in 14.8% of symptomatic patients. Polyps were found in 149 and cancer was diagnosed in 94 patients of whom one third were asymptomatic. Eighty percent of the latter had Dukes' A and B lesions, 12% had Dukes' C lesions, and 8% had Dukes' D lesions. In contrast, only 36% of the symptomatic cancers were Dukes' A and B lesions, and 69% were Dukes' C and D lesions. These results suggest that primary care physicians can be effective in the screening and detection of precancerous polyps and early-staged colorectal cancers.