A community screening program can only change mortality and morbidity rates if the screening program has adequate sensitivity for the target disease and is both readily available and acceptable to the screening population. Furthermore, the program must reduce mortality in a cost- effective manner. To reduce colorectal cancer mortality, the targets are curable cancer and adenomas. Colonoscopy is about 95% sensitive for colorectal cancer and 70% to 90% sensitive for adenomas, depending on size. Barium enema is about 90% sensitive for cancer [though sensitivity is unknown in asymptomatic populations) but is relatively insensitive for adenomas. Barium enema is readily accessible in most Western countries, but colonoscopy is not. Neither is acceptable to the screening population in general, as participation rates are low. Although education of the public and endorsement by doctors may improve this, poor participation greatly limits their ability to influence community rates. Nonetheless, colonoscopy adds the important dimension of adenoma detection in colorectal cancer prevention, and it could serve simultaneously as the screening tool, diagnostic test, and therapeutic maneuver. In addition, cost-effectiveness models suggest that colonoscopy and barium enema may be comparable to alternate screening modalities such as fecal occult blood testing. Until more evidence is gained in true screening populations, neither colonoscopy nor barium enema can be supported as the primary tool for colorectal cancer screening in asymptomatic subjects. (C) 2000 by W.B. Saunders Company.
|Number of pages||7|
|Journal||Seminars in Colon and Rectal Surgery|
|Publication status||Published - 2000|