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Bmj Usa: Editorial

New colorectal cancer screening guidelines

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E196
  1. Sidney J Winawer, Paul Sherlock chair in medicine (
  1. Memorial Sloan-Kettering Cancer Center, New York City

    A consensus for action

    From BMJ USA 2003;Mar:126

    Colorectal cancer is an important health issue in the United States. Every year it accounts for approximately 130 000 new cases and 55 000 deaths among both men and women, costs more than $6 billion, and claims approximately 165 000 life-years.1 Guidelines published years ago suggested that screening could reduce this toll by detecting early-stage curable cancer. We had known for four decades that colorectal cancer evolved slowly from premalignant polyps, providing a long window of opportunity to detect cancer early, and possibly, to remove polyps and thereby prevent cancer altogether.1

    It was not until new technological advances in the early 1970s that screening became feasible, however. These developments included guaiac cards with a stable reagent, flexible sigmoidoscopy, and colonoscopy. This gave clinicians the total package of screening tests and a means of accurate diagnostic work-up and effective treatment with polypectomy and curative surgery. Screening was challenged for years because of concerns over screening bias, overdiagnosis, and harms. However, the largest criticism—that screening was not proven to reduce mortality from colorectal cancer—was laid to rest in the 1990s …

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