Improving the Cost-Effectiveness of Colorectal Cancer Screening

From several perspectives, prevention of colorectal cancer by adenoma detection is gaining acceptance as a more desirable goal for screening than detection of asymptomatic, early-stage cancer. While clinical trials of fecal occult blood (FOB) screen-ing (1–4) have shown substantial reductions in colorectal cancer mortality, incidence rates appear to remain unaffected. This finding suggests that, while some adenomas certainly bleed and are detectable by the FOB test, the main yields from FOB screening are early-stage asymptomatic cancers that have supe-rior prognoses to clinically detected cancers. To detect adeno-mas in quantity, endoscopy is currently the most sensitive method available. The results of an economic analysis by Loeve et al. (5) in this issue of the Journal show that flexible sigmoidoscopy (FS) screening not only can be cost-effective but, under certain as