Breast and Colorectal Cancer Screening

U.S. Primary Care Physicians' Reports of Barriers


      Primary care physicians (PCPs) play a key role in performing and referring patients for cancer screening. Understanding barriers to test use is critical to developing strategies that promote adherence to clinical guidelines, but current literature does not distinguish the extent to which barriers may be similar or unique across screening modalities.


      To describe PCPs' self-reported perceptions of barriers to screening for breast and colorectal cancer (CRC) and compare the top three barriers associated with these screening modalities.


      Cross-sectional data analyzed in 2011 from a nationally representative survey of 2478 PCPs in the U.S. in 2006–2007.


      PCPs reported greater barriers for CRC screening than for mammography. Lack of patient follow-through to complete recommended screening and the inability to pay for tests were the main barriers perceived by PCPs for both types of screening. Another major barrier cited was that patients do not perceive CRC as a threat. This was a lesser concern for the well-diffused message about the need for mammography.


      This is the first national study to provide a comparison of physician-perceived barriers to breast and CRC screening. Study results suggest that efforts to improve use of cancer screening, and CRC screening in particular, will require interventions at physician, practice, and health-system levels.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • U.S. Preventive Services Task Force
        Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2009; 151: 716-726
        • U.S. Preventive Services Task Force
        Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2008; 149: 627-637
        • Swan J.
        • Breen N.
        • Coates R.J.
        • Rimer B.K.
        • Lee N.C.
        Progress in cancer screening practices in the U.S.: results from the 2000 National Health Interview Survey.
        Cancer. 2003; 97: 1528-1540
        • CDC
        Cancer screening—U.S., 2010.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 41-44
        • Breen N.
        • Meissner H.I.
        Toward a system of cancer screening in the U.S.: trends and opportunities.
        Annu Rev Public Health. 2005; 26: 561-582
        • Taplin S.H.
        • Taylor V.
        • Montano D.
        • Chinn R.
        • Urban N.
        Specialty differences and the ordering of screening mammography by primary care physicians.
        J Am Board Fam Pract. 1994; 7: 375-386
        • Klabunde C.N.
        • Vernon S.W.
        • Nadel M.R.
        • Breen N.
        • Seeff L.C.
        • Brown M.L.
        Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.
        Med Care. 2005; 43: 939-944
        • Nodora J.N.
        • Martz W.D.
        • Ashbeck E.L.
        • Jacobs E.T.
        • Thompson P.A.
        • Martinez M.E.
        Primary care physician compliance with colorectal cancer screening guidelines.
        Cancer Causes Control. 2011; 22: 1277-1287
        • Vedel I.
        • Puts M.T.E.
        • Monette M.
        • Monette J.
        • Bergman H.
        Barriers and facilitators to breast and colorectal cancer screening of older adults in primary care: a systematic review.
        J Geriatr Oncol. 2011; 2: 85-98
        • Zapka J.M.
        • Klabunde C.N.
        • Arora N.K.
        • Yuan G.
        • Smith J.L.
        • Kobrin S.C.
        Physicians' colorectal cancer screening discussion and recommendation patterns.
        Cancer Epidemiol Biomarkers Prev. 2011; 20: 509-521
        • Anhang Price R.
        • Zapka J.
        • Edwards H.
        • Taplin S.H.
        Organizational factors and the cancer screening process.
        J Natl Cancer Inst Monogr. 2010; 2010: 38-57
        • Klabunde C.N.
        • Lanier D.
        • Nadel M.R.
        • McLeod C.
        • Yuan G.
        • Vernon S.W.
        Colorectal cancer screening by primary care physicians: recommendations and practices, 2006-2007.
        Am J Prev Med. 2009; 37: 8-16
        • Meissner H.I.
        • Klabunde C.N.
        • Han P.K.
        • Benard V.B.
        • Breen N.
        Breast cancer screening beliefs, recommendations and practices: primary care physicians in the U.S..
        Cancer. 2011; 117: 3101-3111
        • Jones R.M.
        • Woolf S.H.
        • Cunningham T.D.
        • et al.
        The relative importance of patient-reported barriers to colorectal cancer screening.
        Am J Prev Med. 2010; 38: 499-507
        • Lafata J.E.
        • Cooper G.S.
        • Divine G.
        • et al.
        Patient–physician colorectal cancer screening discussions: delivery of the 5A's in practice.
        Am J Prev Med. 2011; 41: 480-486
        • Ling B.S.
        • Trauth J.M.
        • Fine M.J.
        • et al.
        Informed decision-making and colorectal cancer screening: is it occurring in primary care?.
        Med Care. 2008; 46: S23-S29
        • LeMasters T.
        • Sambamoorthi U.
        A national study of out-of-pocket expenditures for mammography screening.
        J Women's Health. 2012; 20: 1775-1783
        • Braun S.
        The history of breast cancer advocacy.
        Breast J. 2003; 9: S101-S103
        • Taplin S.H.
        • Anhang Price R.
        • Edwards H.M.
        • et al.
        Introduction: understanding and influencing multilevel factors across the cancer care continuum.
        J Natl Cancer Inst Monogr. 2012; 2012: 2-10