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

Since 1997, there has been a consensus that screening iseffective in reducing colorectal cancer mortality and is cost-effective (1–4). 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 ” strat-egy can screen, diagnose, and treat by removing premalig-nant 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 fo