Cancer Education Among Primary Care Physicians in an Underserved Community Sherri Sheinfeld Gorin, PhD, Donald Gemson, MD, Alfred Ashford, MD, Susan Bloch, MS, Rafael Lantigua, MD, Habibul Ahsan, MD, Alfred Neugut, MD, PhD, MPH Introduction: Urban minority groups, such as those living in north Manhattan, are generally underserved with regard to cancer prevention and screening practices. Primary care physicians are in a critical position to counsel their patients on these subjects and to order screening tests for their patients. Methods: Eighty-four primary care physicians in two intervention communities who received educational visits about cancer screening and prevention were compared with 38 physi- cians in a nearby community who received no intervention. With pre- and post-test interviews over an 18-month period, the physicians were asked about their attitudes toward, knowledge of (relative to American Cancer Society guidelines), and likelihood of coun- seling and screening for breast, cervical, colorectal, and prostate cancers. Results: Comparison of the two surveys of physicians indicated no statistically significant differences in knowledge of cancer prevention or screening. At post-test, however, intervention group physicians identified significantly fewer barriers to practice than control physicians (p  0.05). While overall, the educational visits to inner-city primary care physicians did not appear to significantly alter cancer prevention practices, there was a positive dose–response relationship among the subgroup of participants who received three or more project contacts. Conclusions: We uncovered significant changes in attitude due to academic detailing among urban primary care physicians practicing in north Manhattan. A significant pre-test sensitization effect and small numbers may have masked overall changes in cancer prevention and screening behaviors among physicians due to the intervention. Medical Subject Headings (MeSH): mass screening, neoplasms, physicians, preventive health services, urban population (Am J Prev Med 2000;19(1):53–58) © 2000 American Journal of Preventive Medicine Introduction P rimary care physicians have an increasingly im- portant role to play in the delivery of cancer prevention and detection services to patients. 1–7 Yet, primary care physician cancer prevention and detection approaches vary considerably, are less com- mon among underserved communities, and are diffi- cult to change. Continuing medical education alone has had limited success in changing physician behav- ior. 8 –11 Face-to-face counseling of physicians, or “aca- demic detailing,” has been found to be effective in numerous diverse individual studies, as well as in a review of 160 continuing medical education strategies. 12–17 While developing an effective means for increasing the prevention behaviors of physicians in general is important, changing the behaviors of those who prac- tice in underserved urban communities is critical. Indi- viduals in these communities manifest poorer health status and experience more barriers to care, including physicians’ recommending fewer preventive tests and procedures, 18 –30 which may result in later-stages pre- sentation and increased morbidity and mortality from cancer. 31– 43 In this north Manhattan community, the need is even more pressing, given the relatively high From the Herbert Irving Comprehensive Cancer Center, New York Presbyterian Medical Center (Gorin, Ashford, Bloch, Lantigua, Ah- san, Neugut); Department of Medicine, College of Physicians and Surgeons, Columbia University (Ashford, Lantigua, Neugut); Divi- sion of Epidemiology (Gorin, Ahsan, Neugut) and Division of Socio- medical Sciences (Gorin, Gemson), Joseph L. Mailman School of Public Health of Columbia University; and Department of Medicine, Harlem Hospital Center (Ashford), New York, New York Address correspondence to: Sherri Sheinfeld Gorin, PhD, Divisions of Sociomedical Sciences and Epidemiology, Joseph L. Mailman School of Public Health of Columbia University, 600 West 168th Street, New York, NY 10032. E-mail: ssg19@columbia.edu. Address reprint requests to: Alfred I. Neugut, MD, PhD, Depart- ment of Medicine, College of Physicians and Surgeons, Columbia University and Division of Epidemiology, Joseph L. Mailman School of Public Health of Columbia University, 622 West 168th Street, New York, NY 10032. 53 Am J Prev Med 2000;19(1) 0749-3797/00/$–see front matter © 2000 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(00)00153-7