To the Editor There is a paucity of strong empirical evidence to inform crucial policy decisions on the comparative screening effectiveness of colorectal cancer tests, as Dr Redberg noted in an Editorial in a recent issue of JAMA Internal Medicine.1 However, more randomized clinical trials (RCT) may not be the answer to this scientific conundrum, although there is reasonable equipoise for a study colonoscopy vs sigmoidoscopy plus high-sensitivity guaiac or immunochemical fecal occult blood test (FOBT). Unfortunately, non-US studies may not adequately capture the experience of many American clinicians and patients, and current US RCTs may be underpowered to provide answers about effectiveness in the entire colon.
Doubeni CA. Colorectal Cancer Screening Comparative Effectiveness—Clinical Trials Are Not Always the Answer. JAMA Intern Med. 2017;177(1):143–144. doi:10.1001/jamainternmed.2016.7831
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