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November 13, 2006

Colon Cancer Screening: The Good, the Bad, and the Ugly

Arch Intern Med. 2006;166(20):2177-2179. doi:10.1001/archinte.166.20.2177

This year, it is estimated that there will be 55 170 colorectal cancer (CRC)–related deaths, making it the second leading cause of cancer-related deaths among Americans.1 If detected early, CRC is eminently curable; however, given the insidious nature of CRC, only about one third of patients are diagnosed as having the cancer at the localized stage.1 This underscores the need for effective screening of the population at risk, primarily those older than 50 years. There are several recommended CRC screening tests, including fecal occult blood tests (FOBTs), flexible sigmoidoscopy, and air-contrast barium enema, spanning a range of cost, invasiveness, discomfort, and accuracy.2 Fecal occult blood testing is the least expensive intrusive test, whereas colonoscopy is the most accurate but also the most invasive test. Fecal occult blood testing and colonoscopy have been proved to not only decrease mortality but also prevent CRC occurrence (by 20% and 65%-90%, respectively) through identification and removal of the precursor lesion, the adenomatous polyp.2,3 However, CRC screening rates are significantly below those seen for breast or prostate cancer,4 with only one fourth to one third of eligible patients receiving any type of CRC screening.5

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