Authors Russell Harris, MD, MPH, and Linda S. Kinsinger, MD, MPH, from the University of North Carolina in Chapel Hill, wrote recently that in considering the benefit from increased colonoscopy screening, physicians must also consider the increased harm and cost. The editorial was published in the Journal of the National Cancer Institute.
In 2000, Daniel Podolsky, MD, from the University of Texas Southwestern Medical Center in Dallas, wrote an editorial in the New England Journal of Medicine that dubbed colonoscopy "going the distance" and prompted the screening colonoscopy to become the standard method in the U.S. In most other developed countries, primary fecal occult blood tests or fecal immunochemical tests with or without flexible sigmoidoscopy are used instead of colonoscopy, the authors said.
The authors also note the problem of overdiagnosis, which also affects breast and prostate cancers. Current practice in the U.S. is to remove all polyps, regardless of size and risk factor, even though that increases the risk of complications.
"When our goal changes from reducing mortality within reasonable levels of harms and costs to eradicating every existing polyp, we are taking our eyes off the ball," the authors wrote.
The authors suggest that less-intensive screening with careful analysis of risk factors might be a better option.
"If not going the distance means fewer harms to patients, more participation by underscreened groups, fewer opportunity costs to the health-care system, and a lower overall cost for CRC screening, then less colonoscopy can mean more well-being for us all," they wrote.
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In 2000, Daniel Podolsky, MD, from the University of Texas Southwestern Medical Center in Dallas, wrote an editorial in the New England Journal of Medicine that dubbed colonoscopy "going the distance" and prompted the screening colonoscopy to become the standard method in the U.S. In most other developed countries, primary fecal occult blood tests or fecal immunochemical tests with or without flexible sigmoidoscopy are used instead of colonoscopy, the authors said.
The authors also note the problem of overdiagnosis, which also affects breast and prostate cancers. Current practice in the U.S. is to remove all polyps, regardless of size and risk factor, even though that increases the risk of complications.
"When our goal changes from reducing mortality within reasonable levels of harms and costs to eradicating every existing polyp, we are taking our eyes off the ball," the authors wrote.
The authors suggest that less-intensive screening with careful analysis of risk factors might be a better option.
"If not going the distance means fewer harms to patients, more participation by underscreened groups, fewer opportunity costs to the health-care system, and a lower overall cost for CRC screening, then less colonoscopy can mean more well-being for us all," they wrote.
Related Articles on Colorectal Cancer:
Almac Creates Test to Predict Likelihood of Colon Cancer Recurring
Clear Liquid Diet Before Colonoscopy Not Essential
Study: Poor Men More Likely to Die of Colorectal Cancer