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November 7, 1977

Screening for Colorectal Cancer-Reply

JAMA. 1977;238(19):2014-2015. doi:10.1001/jama.1977.03280200026004

In Reply.—  Dr Winawer's criticisms of our study are cogent and reflect his wide experience in this field. We may indeed have missed colorectal cancers in our population, although this has not become apparent in a two-year follow-up of most of our screenees.An analysis of cancer incidence data in our area indicates that two cases of colorectal cancers will appear in our patient cohort each year; we detected none. In one woman, aged 66 years, obstruction from a large carcinoma of the ascending colon did develop 16 months after she participated in our study. Her three Hemoccult (HO) slides were negative.We chose to collect three stool specimens on each screenee rather than the six suggested by Greegor1 and by Winawer. Neuhauser and Lewicki2 analyzed the six sequential stoolguaiac protocol as a screen for colonic cancer. They showed that there was little gain in the true positive