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October 12, 1994

Screening for Colorectal Cancer: Which Test Is Best?

Author Affiliations

Kaiser Permanente Los Angeles Medical Center Los Angeles, Calif

JAMA. 1994;272(14):1100. doi:10.1001/jama.1994.03520140029018

To the Editor.  —We found the article by Drs Lang and Ransohoff1 on the utility of the FOBT screening for CRC very interesting. Their results suggest that one third to one half of the mortality reduction observed in the widely cited Minnesota Colon Cancer Control Study of FOBT screening using rehydrated slides2 may be attributable to chance selection for colonoscopy. They further assert that with long-term annual FOBT screening with rehydration the chance of undergoing colonoscopy approaches 100% and, therefore, it may be a more effective strategy to simply screen everyone directly with colonoscopy (eg, when a person reaches a certain age).We agree that universal endoscopic screening would be a more direct approach to screening for CRC. Such a direct approach would eliminate the annual costs of laboratory processing, record keeping, and follow-up associated with doing annual FOBT screening. We would further suggest that any universal endoscopic

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