Christian Jackson, MD; Robert Craig, MD
Potential Financial Conflicts of Interest: None disclosed.
Jackson C., Craig R.; Office-Based Testing for Fecal Occult Blood. Ann Intern Med. 2005;143:235-236. doi: 10.7326/0003-4819-143-3-200508020-00016
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Published: Ann Intern Med. 2005;143(3):235-236.
TO THE EDITOR:
We read with interest the article by Collins and colleagues (1) and the accompanying editorial by Dr. Sox (2). We share Dr. Sox's concern that colorectal cancer mortality rates have not decreased more rapidly, considering the emphasis on increased screening over the past 10 years. We think this is multifactorial, and we would like to respond to these observations before the office-based FOBT is abandoned.
One reason for the slow decline might be the replacement of flexible sigmoidoscopy with total colonoscopy for people at low risk for colorectal cancer. With the exception of the Veterans Administration health system, this practice has produced a chasm between those who can afford total colonoscopy or insist on it versus those who cannot. A paucity of any screening intervention in the African-American and Hispanic populations is troubling because available data show that colon cancer is diagnosed more frequently in African-American and Hispanic persons than in white persons (3, 4).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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