Old habits die hard: chest radiography for screening purposes in primary care (Journal article)

Mauri, D./ Kamposioras, K./ Proiskos, A./ Xilomenos, A./ Peponi, C./ Dambrosio, M./ Zacharias, G./ Koukourakis, G./ Pentheroudakis, G./ Pavlidis, N.

OBJECTIVE: To assess whether the use of chest radiography for screening changes over time. DESIGN: Systematic review. DATA SOURCES: MEDLINE, ISI, Cochrane Central Register of Controlled Trials, and handsearching of selected journals. REVIEW METHODS: We evaluated whether the proportion of primary care physicians using chest radiography to screen for (1) malignancy in the general asymptomatic population, (2) malignancy in a high-risk subgroup, (3) any disease in the general population, and (4) any disease in a high-risk subgroup changed over time, using random-effects meta-regression analysis. Adjustments for the availability of national guidelines were also performed. RESULTS: Overall, 10% to 90% of primary care physicians reported using chest x-ray for screening. In unadjusted analyses, the proportion of physicians using chest radiography for cancer screening in the general population tended to increase by 0.9% per year (8 studies, n = 4313). The corresponding annual changes were -2.9% for cancer screening in high-risk subgroups (8 studies, n = 2784) and -0.4% regarding screening for any disease in the population (7 studies, n = 2627). No meta-regressions were run for outcome (4) (only 1 study). In the adjusted analyses, there was a decreasing nonsignificant trend for all outcomes. CONCLUSIONS: Despite formal recommendations, many physicians still use chest x-ray for screening, with their number decreasing slowly over time. This practice may be harmful because the positive predictive value of chest radiography is low, and further evaluation of false-positive findings might be associated with increased cost and risk from additional diagnostic or therapeutic interventions.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Keywords: Humans,Mass Screening/*utilization,Physician's Practice Patterns/*trends,Predictive Value of Tests,Primary Health Care/*trends,Radiography, Thoracic/*utilization,Risk Assessment
URI: http://olympias.lib.uoi.gr/jspui/handle/123456789/19651
ISSN: 1088-0224
Link: http://www.ncbi.nlm.nih.gov/pubmed/17090221
Appears in Collections:Άρθρα σε επιστημονικά περιοδικά ( Ανοικτά)

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