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Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors
  1. Berit Bringedal1,
  2. Atle Fretheim2,
  3. Stein Nilsen3,
  4. Karin Isaksson Rø1
  1. 1 LEFO-Institute for Studies of the Medical Profession, Oslo, Norway
  2. 2 Nasjonalt folkehelseinstitutt, Oslo, Norway
  3. 3 AFE, Uni Helse, Bergen, Norway
  1. Correspondence to Dr Berit Bringedal; berit.bringedal{at}


Objective Guidelines for cancer screening have been debated and are followed to varying degrees. We wanted to study whether and why doctors recommend disease-specific cancer screening to their patients.

Design Our cross-sectional survey used a postal questionnaire. The data were examined with descriptive methods and binary logistic regression.

Setting We surveyed doctors working in all health services.

Participants Our participants comprised a representative sample of Norwegian doctors in 2014/2015.

Primary and secondary outcome measures The primary outcome is whether doctors reported recommending their patients get screening for cancers of the breast, colorectum, lung, prostate, cervix and ovaries. We examined doctors’ characteristics predicting adherence to the guidelines, including gender, age, and work in specialist or general practice. The secondary outcomes are reasons given for recommending or not recommending screening for breast and prostate cancer.

Results Our response rate was 75% (1158 of 1545). 94% recommended screening for cervical cancer, 89% for breast cancer (both established as national programmes), 42% for colorectal cancer (upcoming national programme), 41% for prostate cancer, 21% for ovarian cancer and 17% for lung cancer (not recommended by health authorities). General practitioners (GPs) adhered to guidelines more than other doctors. Early detection was the most frequent reason for recommending screening; false positives and needless intervention were the most frequent reasons for not recommending it.

Conclusions A large majority of doctors claimed that they recommended cancer screening in accordance with national guidelines. Among doctors recommending screening contrary to the guidelines, GPs did so to a lesser degree than other specialties. Different expectations of doctors’ roles could be a possible explanation for the variations in practice and justifications. The effectiveness of governing instruments, such as guidelines, incentives or reporting measures, can depend on which professional role(s) a doctor is loyal to, and policymakers should be aware of these different roles in clinical governance.

  • Cancer screening
  • Gatekeeping
  • Norway
  • Doctors' roles

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  • Contributors BB designed the study, analysed the results, interpreted the data and drafted the article. AF interpreted the data, reviewed the current evidence of cancer screening and revised the article. SN interpreted the data and revised the article. KIR designed the study, analysed the results, interpreted the data and revised the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval All participants have given their written consent. The Norwegian Regional Committee for Medical Research Ethics has exempted the survey from review since it does not include patient data (approval no IRB 00001870).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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