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To the Editor.—
The letter by S. Bharath, MD, and the reply by Morton J. Goodman, MD (242:140, 1979), focus on the problem of false-positive Hemoccult slides in colorectal cancer screening and the high cost of complete diagnostic follow-up examinations. It is understandable how any physician and his asymptomatic patient can be frustrated by a $500 workup that discloses absolutely nothing.Large-scale studies supported by grants must be complete to furnish us necessary statistics and guidelines. Until then, however, most of us can afford to be a little more discriminating. To reduce needless full-colon workups, I have adopted the following routine.In elderly patients where occurrence of colon pathology is high, those with positive Hemoccult test results deserve the minimum sigmoidoscopic examination and barium enema with air contrast. Hemorrhoidal bleeding, of course, must be ruled out. If these are negative, the Hemoccult test should be repeated in one or two
Greegor DH. Colorectal Cancer Screening. JAMA. 1980;243(2):119. doi:10.1001/jama.1980.03300280017010