15 - 17 Inappropriate screening may be associated with health care waste and potential unintended harm (eg, additional downstream diagnostic tests). For instance, because of a low diagnostic yield, anemia screening is not recommended for adults except during pregnancy, and recommendations about screening during pregnancy are mixed. 11 - 14 However, variation related to testing practices, interpretation of laboratory test results, and diagnostic evaluation of IDA among physicians is not well studied even though these factors may be associated with diagnostic delays, missed cancer diagnoses, and low-value care. 9, 10Ĭlinical practices related to identification and evaluation of IDA likely vary substantially, with at least 30 different guidelines from 10 specialty societies. 7, 8 This problem is of increasing importance given the increasing incidence of colorectal cancer among younger patients outside the age range for which routine colorectal cancer screening is recommended, for whom IDA may be the first diagnostic sign of malignant neoplasm. However, retrospective studies have reported that delays in diagnostic evaluation of IDA are common 5, 6 and can lead to a delayed diagnosis of colorectal cancer. 3, 4 Prompt and thorough evaluation of IDA is essential. 1, 2 Between 1% and 10% of adult patients with IDA may have undiagnosed GI tract cancer. Iron deficiency anemia (IDA) is a classic early diagnostic sign of gastrointestinal (GI) tract malignant neoplasm. Both misinterpretation of iron studies and underuse of bidirectional endoscopy can lead to delayed diagnosis of gastrointestinal tract cancers and warrant additional interventions. Of 312 participants, 170 (54.5%) recommended bidirectional endoscopy (upper endoscopy and colonoscopy) for new IDA for women aged 65 years of 305 respondents, 168 (55.1%) recommended bidirectional endoscopy for men aged 65 years.Ĭonclusions and Relevance In this survey study, US PCPs’ self-reported testing practices for anemia suggest overuse of screening laboratory tests, misinterpretation of iron studies, and underuse of bidirectional endoscopy for evaluation of new-onset IDA. Interpretation of iron studies was least accurate in a scenario of a borderline low ferritin level (40 ng/mL) with low transferrin saturation (2%) 86 participants (26.5%) incorrectly responded that this scenario did not indicate IDA, and 239 (73.5%) correctly identified this scenario as IDA. A total of 250 participants (76.9%) screened at least some patients for anemia. The mean (SD) duration of clinical experience was 19.8 (11.2) years (range, 1.0-45.0 years). Of the 325 participants who completed surveys, 180 (55.4%) were men age of participants was not assessed. Results Of 631 PCPs who received an invitation to participate in the survey, 356 (56.4%) responded and 31 (4.9%) were excluded, for an adjusted eligible sample size of 600, yielding 325 completed surveys (response rate, 54.2%). Main Outcomes and Measures Descriptive statistics based on survey responses were evaluated for frequency of anemia screening, correct interpretation of iron laboratory studies, and proportion of patients with new-onset IDA referred for gastrointestinal tract evaluation. Participants completed a vignette-based survey to assess practices related to screening for anemia, interpretation of laboratory-based iron studies, and appropriate diagnostic evaluation of IDA. Objective To assess how US primary care physicians (PCPs) approach testing for anemia, interpret iron laboratory studies, and refer patients with IDA for gastrointestinal endoscopy.ĭesign, Setting, and Participants This survey study, conducted in August 2019, included members of the American College of Physicians Internal Medicine Insiders Panel, a nationally representative group of American College of Physicians membership, who self-identified as PCPs. Retrospective studies have reported delays in diagnostic evaluation of IDA as a common factor associated with delayed diagnosis of colorectal cancer. Importance Recognition of iron deficiency anemia (IDA) is important to initiate timely evaluation for gastrointestinal tract cancer. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. Challenges in Clinical Electrocardiography.
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