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1
Colorectal cancer screening by primary care
physicians a prospective chart audit
Bernard DENIS, Guillaume SCHON, Marcel RUETSCH,
Jean Christian GRALL, Michel LEVEQUE, Jean Martin
MEYER, Serge MOSER, Jean Claude TSCHIEMBER,
Philippe PERRIN
Association pour le Dépistage du Cancer
colorectal dans le Haut-Rhin (ADECA 68), 39
avenue de la Liberté, Colmar, France
designed paper tools to aid GPs
Abstract
Results
37 GPs assessed 736 charts
Cancer screening requires 1) identification of
individuals at high risk for cancer mainly
through an adequate family history assessment and
2) documentation of dates and results of past
screening examinations. Little data exist about
the quality of charts in the field of colorectal
cancer screening in primary care. Aim to assess
the completeness of the family history and past
screening examinations interview in primary
care. Methods prospective chart audit of data on
family cancer history and past screening
examinations. Volunteer GPs self audited the
completeness of their charts of 20 (10 men, 10
women) established patients aged 40-74 for
colorectal, breast and cervix cancer. Results 37
GPs participated and 736 charts were analysed.
Family history information on colorectal cancer
was collected on 367 (51.3 ) charts. The
individual rate of family history recording
ranged from 5 to 100 according to GP. Specific
information regarding age at diagnosis and degree
of kinship was present in 103 of the records. 134
charts (20.5 ) mentioned a past colon
examination, but 85 (63.4 ) only mentioned the
date of examination and its result. Among 490
50-74 years old average risk people, 251 charts
(51.2 ) mentioned a past FOBT, 78.5 of them
mentioned the date of the FOBT and 63.3
contained information about family history.
Family history of breast cancer was documented in
139 (49.8 ) charts. 126 charts (62.7 ) of women
aged 50-69 mentioned a past mammogram, but 52
charts only (25.9 ) were complete and correct
for breast cancer screening (family history, date
and result of mammogram and lt 2 years mammogram).
99 charts (44.2 ) of women aged 40-65 mentioned
a past pap smear but 53 charts only (23.7 ) were
complete and correct for cervix cancer screening
(date lt 3 years and result). Conclusion quality
of charts in primary care is globally poor but
very heterogeneous, ranging from bad to excellent
according to GP family history of cancer is
correctly documented in about a half of charts
about a quarter of charts are complete and
correct for each cancer screening (date and
result of past screening examinations documented
and correct, family history collected). The
collection of updated information on family
history and past screening examinations must be
improved in primary care. We designed paper tools
to aid GPs in this task posters and
patient-completed forms intended for GP's waiting
rooms.
Patient-completed forms
Posters for waiting rooms
Colorectal cancer
Aim
Breast cancer
to assess the completeness of the family history
and past screening examinations interview in
primary care
Methods

• volunteer GPs from 6 peer groups
• self audit of charts of 20 established patients
  (10 men, 10 women) aged 40-74 for colorectal,
  breast and cervix cancer
• exclusion of patients
• . 1st time consultant
• . with a history of colorectal, breast or cervix
  cancer
• For each chart a questionnaire
• 10 questions for women (colorectal, breast and
  cervix cancer )
• 5 questions for men (colorectal cancer).

Cervix cancer
Conclusions - Quality of charts in primary care
is globally poor but very heterogeneous, ranging
from bad to excellent according to GP - Family
history of cancer is correctly documented in
about a half of charts - About a quarter of
charts are complete and correct for each cancer
screening (date and result of past screening
examinations documented and correct, family
history collected) - The collection of updated
information on family history and past screening
examinations must be improved in primary care.
Women questionnaire
3 cancers
Digestive Disease Week, Los Angeles, 23 May 2006