This is the first study to investigate personal screening practices in a random sample of HCWs at a tertiary-care hospital in Brazil. We observed great variability in these screening practices.
According to the 1996 USPSTF guidelines, the recommended methods of screening for cardiovascular diseases are measurement of blood pressure (for adults over 20 years of age) and determination of serum cholesterol levels (for males ≥ 35 years of age and for females ≥ 45 years of age). More than 70% of the HCWs investigated in the present study reported having had their blood pressure measured as a screening procedure. It should be noted that this prevalence might have been underestimated given that the measurement of blood pressure in routine clinical appointments might not have been perceived as a screening practice. However, more than 38% of the HCWs of both genders had never undergone serum cholesterol measurement as a screening procedure. This is somewhat higher than the 23% reported by the Behavioral Risk Factor Surveillance System for HCWs in the United States in 2001.11
Although resting ECG is not recommended in asymptomatic individuals without risk factors for cardiovascular diseases, we observed that nearly 50% of the participants had been submitted to this test. The exercise stress test, for which there is also no evidence of a benefit in terms of a reduction in mortality, had been performed on 8% of the respondents (data not shown).
The USPSTF recommends the FOBT as a screening tool for colorectal cancer in all individuals ≥ 50 years of age. Of the 333 HCWs evaluated in the present study, 131 (39%) were in this age group. However, only 3 (1%) reported having undergone this test as a screening procedure. The 2008 Behavioral Risk Factor Surveillance System report11
showed that 20.9% of the participants aged ≥ 50 years had undergone the FOBT within the past two years and that 61.8% had undergone sigmoidoscopy or colonoscopy.
The 1996 USPSTF recommendation for breast cancer screening is mammography (with or without clinical breast examination) for females ≥50 years of age,2
although an update of the guidelines recommends that the age range be expanded to females ≥ 40 years of age.12
In our sample, 28% of the females reported that they had never undergone this test. Although the evidence is insufficient to recommend breast self-examination as a screening practice, 88% of the female HCWs reported performing this examination on themselves, routinely.
Among the female HCWs evaluated, the prevalence of having had at least one Pap smear was 95%. This prevalence was much higher than the 69% and 86% reported, respectively, by Nascimento et al.7
and Pinho et al.13
for females in the city of São Paulo.
Although the 1996 and 2008 USPSTF guidelines do not recommend PSA testing as a screening procedure, 67% of the male HCWs who participated in the present study reported having had the test. A high prevalence of PSA testing (78.6%) was also reported among 135 lecturers and professors ≥ 51 years of age at a medical school in Belo Horizonte, Brazil.14
Regarding the other screening procedures investigated in the present study (urine test, Mantoux test, chest X-ray and bone densitometry), a large proportion of HCWs reported having undergone these tests several times. However, except for bone densitometry (recently given a grade B recommendation among females ≥ 65 years of age), the other tests are not recommended.
The present study has several limitations. First, it was conducted at a public, tertiary-care teaching hospital. Therefore, it is not possible to generalize the results to HCWs at other institutions. Second, our sample was composed of a heterogeneous group of HCWs and physicians in various specialties. It has previously been reported that the beliefs of HCWs concerning the effectiveness of different screening practices may vary by specialty.15
Finally, we used the 1996 USPSTF recommendations as the gold standard because there are no Brazilian guidelines for many of these screening procedures. However, there are guidelines established by other foreign institutions that differ from the USPSTF guidelines.