Five years after the American Cancer Society introduced drastic new guidelines for the early detection of cancer, many doctors are still not following the recommendations, a society survey has found.
``It is discouraging to learn that in many instances the (society`s) guidelines are not being followed even though most physicians agree that they are helpful,`` said Dr. Arthur Holleb, the society`s senior vice president for medical affairs.
Some cancers probably are not being detected in their most curable stages because of a failure to use the screening tests before any symptoms of cancer appear, he said.
The survey disclosed that few doctors routinely use mammography or proctoscopic examinations, which the society believes is important for the early detection of breast and colon cancers.
On the other hand, the study found that many doctors are routinely using chest X-rays to check for lung cancer and yearly Pap smears to check for cervical cancer, neither of which tests the society recommends.
``In many instances, physicians` use of detection procedures does not conform with guidelines for the cancer-related checkup recommended by the American Cancer Society,`` the study says.
One of the main problems uncovered in the survey is that many physicians do not understand that the tests are designed to screen people for early cancers that have not yet developed signs or symptoms, Holleb said.
Many doctors instead use the tests to diagnose tumors after symptoms appear, he said. Once symptoms appear a patient should undergo a whole battery of diagnostic tests, he said.
``The purpose of the guidelines is to detect early cancers before there is even any suspicion of cancer,`` he said. ``A person with symptoms should undergo a regular workup, not screening.``
The survey disclosed that 82 percent of physicians do not follow society recommendations for using mammograms to detect early breast cancer and that 89 percent do not follow the guidelines for using proctoscopic examinations for detecting colon cancer.
Both are common cancers. An estimated 119,000 American women will develop breast cancer this year, and 38,700 probably will die from the disease. Cancer of the colon and rectum is expected to affect 138,000 people this year, and 66,000 will die from it.
President Reagan`s recent close call with colon cancer has stimulated a tremendous interest in the disease and is expected to increase screening programs significantly, according to society officials.
The survey, conducted last fall, involved 1,035 practicing primary-care physicians randomly selected from around the country.
The society`s revised guidelines were based on studies to determine the scientific value of screening tests and to determine their cost-benefit ratio, Holleb said.
``The society`s goal was to reduce the morbidity and mortality of cancer in the most cost-effective way possible,`` he said.
Since other medical organizations devise their own guidelines for cancer detection, many doctors will follow one set of recommendations or another, or accept part of a series of recommendations and reject others, he said.
Often, however, many recommendations are based on what appears to be good advice, but the recommendations never have been subjected to careful scrutiny to determine their scientific validity, he said.
``Overall, it is encouraging to learn that most primary-care physicians are engaged in some form of cancer detection and that most are increasing their efforts,`` Holleb said.
For instance, 8 out of 10 physicians follow the society`s guidelines for breast physical examination, the survey found. About half of the doctors also follow the guidelines for digital rectal examinations and for stool blood testing.