Robert C. Burack, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Burack RC. Life Expectancy and Colorectal Cancer Screening. Ann Intern Med. 2007;146:758. doi: 10.7326/0003-4819-146-10-200705150-00017
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Published: Ann Intern Med. 2007;146(10):758.
TO THE EDITOR:
Gross and colleagues (1) provide important information demonstrating the expected reduction in life expectancy that accompanies advancing age and higher burden of comorbid conditions among patients with newly diagnosed colorectal cancer. While their observations may be particularly informative when considering treatment options after diagnosis of colorectal cancer, the direct relevance of their observations to decision making about screening is somewhat more complex. If the benefit of endoscopic screening for colorectal cancer derives from an earlier diagnosis of cancer, then life expectancy at the time of diagnosis is particularly relevant. However, to the extent that the endoscopy offers benefit through the identification and removal of colorectal polyps among patients without colorectal cancer, decisions about screening might better reflect consideration of life expectancy among individuals without colorectal cancer. While the issues of advancing age and comorbid conditions are still quite relevant (2, 3), knowing the extent to which the estimates of Gross and colleagues are sensitive to the presence of colorectal cancer would be of interest.
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