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Comment & Response
January 2017

Colorectal Cancer Screening Comparative Effectiveness—Clinical Trials Are Not Always the Answer

Author Affiliations
  • 1University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, Philadelphia
JAMA Intern Med. 2017;177(1):143-144. doi:10.1001/jamainternmed.2016.7831

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.