Cost-Effectiveness Studies Fan Colonoscopy Debate

Extract

It was not so long ago that colorectal cancer screening was a remote topic for most Americans. That tenor is changing rapidly. With high-profile celebrities endorsing screening, bills pending in Congress and several states, and a rash of studies out examining the accuracy and cost-effectiveness of screening, momentum for mounting effective colorectal cancer screening programs is high, and colonoscopy figures prominently in that discussion.

Two separate studies, published in the July 20 New England Journal of Medicine, showed that flexible sigmoidoscopy misses proximal lesions (lesions in the ascending and transverse colon close to the small intestine) that are seen with colonoscopy. This fueled the move by some to embrace colonoscopy as the screening test of choice. Some read those studies as compelling enough to sound the death knell for fecal occult blood testing (FOBT) and flexible sigmoidoscopy, although others note that it was known for some time that flexible sigmoidoscopy could not detect proximal lesions.