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Screening Sigmoidoscopy: Can the Road to Colonoscopy Be Less Traveled?

Sidney J. Winawer, MD
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From Memorial Sloan-Kettering Cancer Center; New York, NY 10021.

Requests for Single Reprints: Sidney J. Winawer, MD, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021; e-mail, winawers@mmskc.org.

Ann Intern Med. 2003;139(12):1034-1035. doi:10.7326/0003-4819-139-12-200312160-00013
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Since 1997, there has been a consensus that screening is effective in reducing colorectal cancer mortality and is cost-effective (14). Colorectal cancer screening has now become the standard of medical practice, and failure to screen has become a basis for malpractice suits. Guidelines suggest a 1- or a 2-stage screening approach. The 1-stage approach is to screen average-risk men and women with colonoscopy every 10 years. This “1-stop shopping” strategy can screen, diagnose, and treat by removing premalignant adenomatous polyps. The 2-stage approach requires people to have an annual fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, or both, followed by colonoscopy if the FOBT result is positive or a polyp is present on sigmoidoscopy. More sensitive guaiac-based FOBTs, newer immunochemical FOBTs (5), and a test for stool DNA mutations have expanded available options for detecting neoplasia. Virtual colonoscopy detects polyps or cancer by reconstructing computed tomographic images (1).

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