Screening Refusal Associated with Choice of Colorectal Cancer Screening Methods. A Cross-sectional Study Among Swiss Primary Care Physicians

  • Yonas MartinEmail author
  • Alexander Leonhard Braun
  • Nikola Biller-Andorno
  • Jean-Luc Bulliard
  • Jacques Cornuz
  • Kevin Selby
  • Reto Auer


Guidelines recommend primary care physicians (PCPs) offer patients a choice of colorectal cancer (CRC) screening methods, including colonoscopy and fecal occult blood tests (FOBT).1 However, in countries like the USA and Switzerland, patients are screened almost exclusively with colonoscopy.2, 3 When offered both tests, patients appear as likely to choose one as the other; the predominance of colonoscopy may largely be explained by physician preference and local medical culture.4 Offering only colonoscopy might explain why screening rates are low.

We sought to determine the proportions of patients who opted for screening with colonoscopy or FOBT and who refused testing among 50–75 year olds eligible for screening at a PCP visit. We described variation in care between PCPs and tried to identify PCP-level factors associated with testing method and refusal.


We conducted a cross-sectional data collection on CRC screening practices at PCP level. We invited 129 PCPs from...



We thank the primary care physicians from the Sentinella network and the Sentinella administration as well as the Section Notification Systems at the Federal Office of Public Health for their help collecting this data. We thank Kali Tal for the thorough editing of this work. We thank Emanuele Prati for his help in the data collection. We thank Charles Dvořák for the great help in the conduction of the study among Sentinella PCPs. We thank Cyril Ducros for his comments to this work.


This work was supported by the funds from the Swiss National Scientific Foundations National Research Plan 74 NFP74. 407440_167519. The funders had no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of data; nor in the preparation, review, or approval of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

None of the authors has a conflict of interest related to this manuscript.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Yonas Martin
    • 1
    • 2
    Email author
  • Alexander Leonhard Braun
    • 1
  • Nikola Biller-Andorno
    • 3
  • Jean-Luc Bulliard
    • 4
  • Jacques Cornuz
    • 5
  • Kevin Selby
    • 5
  • Reto Auer
    • 1
    • 5
  1. 1.Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
  2. 2.Department of General Internal Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  3. 3.Institute for Biomedical Ethics and History of Medicine (IBME)UZHZürichSwitzerland
  4. 4.Institute of Social and Preventive Medicine (IUMSP)University of LausanneLausanneSwitzerland
  5. 5.Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland

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