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We read with interest the recent editorial by Professor S. Winaver
regarding the new colorectal screening guidelines published by the US
Multisociety Task Force on Colorectal Cancer(1) . This paper updates
guidelines from 1997 and is a useful consensus document (2)
We agree with the concept of screening and these guidelines used by
clinicians who will counsel individuals regarding different options of
screening and associated potential benefits and risks will be very useful.
The final sentence of the article however “ Any screening test is
better than none” is both very emotive and shows a complete lack of
understanding of screening and the problems associated with it. Along the
same lines the statement “The message to patients should be to get
screened now. Any screening test is better than none and can be life-
saving”(1) needs to be challenged. The personal costs of screening
include financial - fees for medical services, time off work, transport
and other costs of accessing services. There may be anxiety from positive
test results (false or true), and discomfort, pain and rarely death. These
factors need to weighed prior to screening when it is expected that the
vast majority of patients will get no benefit from the testing.
From screening individuals to population screening is a complex
process. In New Zealand, The New Zealand National Health Committee working
party on Population screening for colorectal cancer in 1998 was unable to
recommend a screening process. (3) The main factors that this group felt
made it difficult to recommend population screening by either FOBT or
endoscopic methods included expected low participation rates, commitment
of considerable health sector resources, real potential for harm –
physical and emotional. (3)
Population screening is a very political issue in any aspect of
medicine and any countries entertaining introducing it. Often pressures
from different self intrested groups influence what happens. With these
issues in mind it would be interesting to know the views of Professor
Winaver on population screening.
(1) Winawer SJ. New colorectal cancer screening guidelines. BMJ USA
2003;3 :126-7
(2) Winawer SJ, Fletcher R, Rex D, et al Colorectal cancer screening and
surveillance: clinical guidelines and rationale-update based on new
evidence. Gastroenterology 2003: 123: 544-560
(3) Population screening for colorectal cancer.Working Party on Screening
for Colorectal Cancer, National Advisory Committee on Health and
Disability, Ministry of Health, Wellington, New Zealand
Population screening for colorectal cancer
Editor:
We read with interest the recent editorial by Professor S. Winaver
regarding the new colorectal screening guidelines published by the US
Multisociety Task Force on Colorectal Cancer(1) . This paper updates
guidelines from 1997 and is a useful consensus document (2)
We agree with the concept of screening and these guidelines used by
clinicians who will counsel individuals regarding different options of
screening and associated potential benefits and risks will be very useful.
The final sentence of the article however “ Any screening test is
better than none” is both very emotive and shows a complete lack of
understanding of screening and the problems associated with it. Along the
same lines the statement “The message to patients should be to get
screened now. Any screening test is better than none and can be life-
saving”(1) needs to be challenged. The personal costs of screening
include financial - fees for medical services, time off work, transport
and other costs of accessing services. There may be anxiety from positive
test results (false or true), and discomfort, pain and rarely death. These
factors need to weighed prior to screening when it is expected that the
vast majority of patients will get no benefit from the testing.
From screening individuals to population screening is a complex
process. In New Zealand, The New Zealand National Health Committee working
party on Population screening for colorectal cancer in 1998 was unable to
recommend a screening process. (3) The main factors that this group felt
made it difficult to recommend population screening by either FOBT or
endoscopic methods included expected low participation rates, commitment
of considerable health sector resources, real potential for harm –
physical and emotional. (3)
Population screening is a very political issue in any aspect of
medicine and any countries entertaining introducing it. Often pressures
from different self intrested groups influence what happens. With these
issues in mind it would be interesting to know the views of Professor
Winaver on population screening.
(1) Winawer SJ. New colorectal cancer screening guidelines. BMJ USA
2003;3 :126-7
(2) Winawer SJ, Fletcher R, Rex D, et al Colorectal cancer screening and
surveillance: clinical guidelines and rationale-update based on new
evidence. Gastroenterology 2003: 123: 544-560
(3) Population screening for colorectal cancer.Working Party on Screening
for Colorectal Cancer, National Advisory Committee on Health and
Disability, Ministry of Health, Wellington, New Zealand
Competing interests:
None declared
Competing interests: No competing interests