The potential benefits of screening include the early detection of disease, the prevention of serious illness or disability and improved survival.^3,4 However, not all screening procedures have shown benefits, and some may cause harm to the health of the individual.⁵

Various studies have shown that certain screening practices are performed in an inappropriate manner.^6–9 For instance, although many females in developing countries undergo an annual Papanicolaou (Pap) smear, there are also many who have never had one. In addition, urine tests, electrocardiography (ECG) and blood workups are frequently carried out as screening procedures, despite the fact that there is no evidence that these tests provide benefits. In contrast, other procedures that are known to be effective, such as the fecal occult blood test (FOBT) for colorectal cancer in individuals 50 years of age or older, are rarely performed.

Physicians and other health care workers (HCWs) are a direct source of health information for the population. Therefore, it is important that the information they disseminate be accurate and that the screening procedures they recommend be appropriate. In addition, previous studies have reported that the personal health habits of physicians are major predictors of their counseling practices.^8,10

The inclusion criteria were being 40–69 years of age and an employee of the hospital. Individuals on leave were ineligible. Subjects were randomly selected from a list of physicians, nurses and nursing assistants. Sample size was calculated based on the expected frequency of three screening procedures: Pap smear (among females); breast self-examination (among females); cholesterol screening (among both genders).

The selected sample comprised 170 nursing assistants (162 females and 8 males), 26 nurses (all female) and 137 physicians (40 females and 97 males). Face-to-face interviews were conducted by trained personnel. A structured questionnaire was developed specifically for use in the present study. The questionnaire was designed to collect data related to sociodemographic characteristics, medical history and family history of certain diseases, as well as a list of screening procedures. For each procedure, respondents were asked to provide the age at which they were first tested, the number of times they had undergone the test and the time elapsed since the last test. We defined a screening procedure as any procedure to which subjects had been submitted of their own volition or as part of prenatal care or a work-related medical examination. We attempted to clarify the differences between screening practices and diagnostic tests for the participants. The questionnaire included procedures with grades of recommendation of A, B, C, D or E, in accordance with the 1996 edition of the United States Preventive Services Task Force (USPSTF) guidelines for routine screening (Chart 1).² The 17 procedures analyzed were divided into three groups:

Data were entered twice, by two different operators, into a database using the Epi Info program. For each screening procedure, we estimated the proportion of HCWs who had undergone the procedure at least once, and we calculated the corresponding 95% confidence intervals.

The prevalence of screening practices is shown in Table 2. For 204 (61.3%) of the respondents, the determination of serum cholesterol levels had been performed as a screening procedure at least once. Five males and 95 females began to monitor their cholesterol levels before the ages of 35 and 45 years, respectively. Resting ECG as a screening procedure was reported by 159 (47.7%) subjects, and 25% reported having undergone ECG more than six times.

Regarding screening for colorectal cancer, only 6 subjects reported having been screened with the FOBT or sigmoidoscopy (Table 2). Of the 228 females, 164 (71.9%) had undergone a mammography as a screening procedure, 219 (96.1%) had undergone their first mammography before the age of 50 and 216 (94.7%) had experienced a Pap smear at least once (Table 2). Of the 105 males, 70 (66.7%) had undergone PSA testing and 34 (32.4%) had been submitted to a digital rectal examination.

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.