Which is more important, the method of screening or the timing of the initial colorectal screening test?
Despite much publicity and education of the public in the United States as to the efficacy of colorectal cancer screening in decreasing mortality from colorectal cancer, only 40-50 percent of eligible, average risk patients (i.e., over age 50) have been screened for colorectal cancer at the present time. The reasons for the poor compliance with recommendations are unclear, but some of the lack of screening may relate to the uncertainty as to the best and most cost-effective screening modality. The question as to which modality is most effective in detecting cancers, and the most cost effective screening strategy, has been looked at by several groups via computer-generated models. Each of these studies has indicated that colonoscopy, flexible sigmoidoscopy, and annual fecal occult blood testing are all cost-effective in terms of cost per life (years saved from death by colon cancer compared with no screening). In terms of timing, computer modeling studies have suggested that a colonosco
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