Conocimientos y actitudes de los médicos de Atención Primaria de Andalucía (España) sobre la detección de personas con riesgo elevado de cáncer de mama y colorrectal / Knowledge and attitude among general practitioners in Andalusia (Spain) on the identification of subjects at high risk of breast and colorectal cancer

OBJETIVOS: Explorar los conocimientos y las actitudes de los médicos de Atención Primaria de Andalucía sobre la detección de personas con riego elevado de cáncer de mama y colorrectal y el cáncer hereditario. MÉTODOS: Estudio descriptivo transversal a partir de una encuesta de opinión on line. Cuestionario de 24 preguntas. Para el análisis estadístico se emplearon medidas de frecuencia y de asociación. Se estableció un nivel de significación para una p < 0,05. RESULTADOS: Tasa de respuesta del 32%, 224 encuestas válidas, un 56% de varones, edad media ± DE de 46 ± 12 años. Los criterios de riesgo alto de cáncer de mama eran conocidos por el 71,4% [IC 95% 65-76], peor en los hábitats mayores (p = 0,014). Podían solicitar mamografía en tumoraciones y en riesgo moderado o elevado el 86%. Respecto al cáncer colorrectal, conocen los criterios de riesgo el 87,9%. Ante un paciente con criterios de sospecha podían solicitar colonoscopia directamente el 58,2% [IC 95% 49-62] y las zonas más pobladas tenían mayor acceso a la petición de colonoscopias (p < 0,0001). Desconocían la existencia de consultas de consejo genético 133 médicos (59,4% [IC 95% 52-65]). CONCLUSIONES: El programa de cribado de cáncer de mama es bien conocido y el acceso a la mamografía es satisfactorio. La mayoría de los médicos consideran adecuado el seguimiento de las personas con alto riesgo de cáncer colorrectal, aunque la mitad de los encuestados refieren dificultades para solicitar la colonoscopia directamente. Los conocimientos sobre cáncer hereditario son deficitarios y variables según las zonas y hay un desconocimiento generalizado sobre la existencia de unidades de consejo genético y cáncer hereditario

AIMS: To assess the knowledge and attitude among general practitioners in Andalusia on the identification of subjects with elevated risk for breast cancer, colorectal cancer, and hereditary cancers, as well as to detect barriers to accessibility to the screening programs. METHODS: A descriptive, cross-sectional study was conducted based on an online survey of 24 questions. Data are shown as frequencies, and association tests were statistically used. The level of significance was set at <.05. RESULTS: Survey response rate was 32%, of which 224 were valid, and included 56% men, and a mean age±DE of 46±12 years. Established criteria for high risk breast cancer were already known by 71.4% [95% CI 65-76], being worst in those living in big cities (P <.014). Among general practitioners, 86% were allowed to order mammography in women with lumps or at moderate to high risk for breast cancer. As regards colorectal cancer, 87.9% of general practitioners knew the risk factors. Among general practitioners, 58.2% [95% CI 49-62] were allowed to order a colonoscopy if clinical suspicion was present, especially if they lived in large cities (P < .0001). CONCLUSIONS: The screening program for breast cancer is well-known by general practitioners, and the access to mammography is successful. Most of the general practitioners consider the follow-up program for persons at high risk for colorectal cancer appropriate, although half of those surveyed had some barriers to ordering colonoscopy. Knowledge on hereditary cancer is limited and varies among areas. There is also a general lack of awareness on hereditary cancer and genetic counselling units

Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE: The aim in this study was to assess the association between individual plasma carotenoid levels (alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, lutein, zeaxanthin) and fruit and vegetable intakes recorded by a calibrated food questionnaire (FQ) and 24-h dietary recall records (24HDR) in nine different European countries with diverse populations and widely varying intakes of plant foods. DESIGN: A stratified random subsample of 3089 men and women from nine countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had provided blood samples and dietary and other lifestyle information between 1992 and 2000, were included. RESULTS: beta-Cryptoxanthin was most strongly correlated with total fruits (FQ r = 0.52, 24HDR r = 0.39), lycopene with tomato and tomato products (FQ r = 0.38, 24HDR r = 0.25), and alpha-carotene with intake of root vegetables (r = 0.39) and of total carrots (r = 0.38) for FQ only. Based on diet measured by FQ and adjusting for possible confounding by body mass index (BMI), age, gender, smoking status, alcohol intake, and energy intake, the strongest predictors of individual plasma carotenoid levels were fruits (R(partial)(2) = 17.2%) for beta-cryptoxanthin, total carrots ((partial)(2) = 13.4%) and root vegetables (R(partial)(2) = 13.3%) for alpha-carotene, and tomato products (R(partial)(2) = 13.8%) for lycopene. For 24HDR, the highest R(partial)(2) was for fruits in relation to beta-cryptoxanthin (7.9%). CONCLUSIONS: Intakes of specific fruits and vegetables as measured by food questionnaires are good predictors of certain individual plasma carotenoid levels in our multicentre European study. At individual subject levels, FQ measurements of fruits, root vegetables and carrots, and tomato products are, respectively, good predictors of beta-cryptoxanthin, alpha-carotene, and lycopene in plasma.