Gastroenterology
Volume 139, Issue 3 , Page 1065, September 2010

Reply

published online 23 July 2010.

Article Outline

 

In our recently published review, we examined the public health impact of colorectal cancer.1 Because colorectal cancer is not uniquely an American or a Western phenomenon, we reviewed the available evidence to discuss screening and surveillance programs throughout the world. Our data regarding the compliance rate for screening in France originates from a review by West et al published in 2009.2 Dr Braillon has insightfully added to this discussion by providing updated figures on participation rates in France. Barriers of language and publication timing unfortunately prevented us from including the references shared by Dr Braillon in our review. We appreciate his contribution.

In reference to the debate about the most appropriate screening strategy, we acknowledge that although debate might not be the best term, the optimal screening strategy remains controversial. In fact, even in the United States where colonoscopy is becoming the dominant screening modality,3, 4 fecal occult blood tests and computed tomographic colonography remain viable screening strategies.5 Indeed, in certain large integrated medical systems such as the Veterans Health Administration, fecal occult blood testing remains the most widely utilized screening test.6 Ultimately, the decision about which test to pursue is less a question of ethics than it is of balancing competing interests and preferences among patients, physicians, and payers.

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References 

  1. Gellad ZF, Provenzale D. Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology. 2010;138:2177–2190
  2. West NJ, Boustiere C, Fischbach W, et al. Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome. Int J Colorectal Dis. 2009;24:731–740
  3. Use of colorectal cancer tests—United States, 2002, 2004, and 2006. MMWR Morbid Mortal Wkly Rep. 2008;57:253–258
  4. Schenck AP, Peacock SC, Klabunde CN, et al. Trends in colorectal cancer test use in the Medicare population, 1998–2005. Am J Prevent Med. 2009;37:1–7
  5. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595
  6. El-Serag HB, Petersen L, Hampel H, et al. The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Arch Intern Med. 2006;166:2202–2208

 Conflicts of interest The authors disclose no conflicts.

PII: S0016-5085(10)01099-1

doi:10.1053/j.gastro.2010.07.037

Refers to article:

  • Colorectal Cancer Screening: From Perspectives to Reality , 23 July 2010

    Alain Braillon
    Gastroenterology September 2010 (Vol. 139, Issue 3, Page 1065)

Gastroenterology
Volume 139, Issue 3 , Page 1065, September 2010

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