Variation in colorectal cancer testing between primary care physicians: a cross-sectional study in Switzerland

  • Alexander Leonhard Braun
  • Emanuele Prati
  • Yonas Martin
  • Charles Dvořák
  • Kali Tal
  • Nikola Biller-Andorno
  • Jean-Luc Bulliard
  • Jacques Cornuz
  • Kevin Selby
  • Reto AuerEmail author
Original article



To determine the proportion of 50–75-year-old patients who visit a primary care physician’s (PCP) office and were tested for colorectal cancer (CRC) by either colonoscopy within 10 years or fecal occult blood testing (FOBT) within 2 years. To describe the variation in care between PCPs and factors associated with these proportions.


Cross-sectional data collected between April and December 2017. Participants: PCPs reporting for the Swiss Sentinel Surveillance Network. Each PCP collected demographic data and CRC testing status from 40 consecutive patients. Measurements: proportions of patients up to date with CRC screening and method used (colonoscopy/FOBT/Other); variation in the outcome measures between PCPs; association of physician-level factors with main outcomes.


91/129 PCPs collected data from 3451 patients; 45% had been tested for CRC within recommended intervals (41% colonoscopy, 4% FOBT). The proportions of patients tested and testing with colonoscopy versus FOBT varied widely between PCPs. Language region was associated with PCPs’ rate of FOBT prescription.


Less than half of patients who visited PCPs in Switzerland were tested for CRC within recommended intervals. PCPs varied widely in their testing practices.


Primary care Colorectal cancer Screening Practice variation Decision making 



This work was supported by the funds from the Swiss National Scientific Foundations National Research Plan 74 (NFP74. 407440_167519). The funder played no role in the design or conduct of the study, in the collection, management, analysis, or interpretation of data, or in the preparation, review, or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors identified a conflict of interest for this manuscript.

Ethical approval

The ethics committee of the canton of Bern waived ethical approval for the study because of the double irreversible patient-data anonymization process (the FOPH cannot identify the patients, and investigators cannot identify the PCPs), so our study fell outside of the scope of the Swiss Human Research Act (REQ-2017-00,280).

Supplementary material

38_2019_1259_MOESM1_ESM.doc (458 kb)
Supplementary material 1 (DOC 457 kb)


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Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  • Alexander Leonhard Braun
    • 1
  • Emanuele Prati
    • 1
  • Yonas Martin
    • 1
  • Charles Dvořák
    • 2
  • Kali Tal
    • 1
  • Nikola Biller-Andorno
    • 3
  • Jean-Luc Bulliard
    • 4
  • Jacques Cornuz
    • 4
  • Kevin Selby
    • 4
    • 5
  • Reto Auer
    • 1
    • 4
    Email author
  1. 1.Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
  2. 2.President Sentinella NetworkBernSwitzerland
  3. 3.Institute for Biomedical Ethics and History of Medicine (IBME)ZurichSwitzerland
  4. 4.University General Medicine and Public Health CentreUniversity of LausanneLausanneSwitzerland
  5. 5.Northern California Division of ResearchKaiser PermanenteOaklandUSA

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