Screening for Colorectal Cancer

Abstract

The articles by Lieberman et al.¹ and Imperiale et al.² (July 20 issue) add greatly to our knowledge about screening for colorectal cancer. However, I disagree with Podolsky,³ who concludes in his editorial that the data in these articles justify universal colonoscopy for adults in the United States; in fact, I believe the data suggest just the opposite — that sigmoidoscopy combined with fecal occult-blood testing is highly effective in screening for colon cancer and is probably the method of choice for patients at average risk for colon cancer. Although it is true, according to both studies, that sigmoidoscopy would miss a substantial proportion of proximal advanced neoplasms, it is also true that in both studies the majority of advanced neoplasms occurred in the distal colon.