Colorectal cancer is a major cause of morbidity and mortality in the United States. Early detection of the disease at an asymptomatic stage by screening holds promise for lowering the incidence of colorectal cancer deaths, yet compliance with screening guidelines is poor. Evidence in support of the use of screening techniques for colorectal cancer is accumulating, however, and screening for this disease with fecal occult blood tests and flexible sigmoidoscopy can increase the likelihood of early detection, can decrease mortality and morbidity, and can be cost effective.
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References
1.
BrownM.National Cancer Institute, 1994 (personal communication).
2.
LevinB., MurphyG.P.Revision in American Cancer Society recommendation for the early detection of colorectal cancer. CA Cancer J Clin.1992; 42: 296–299.
3.
FleischerD.E., GoldbergS.B., BrowningT.H.Detection and surveillance of colorectal cancer. JAMA.1989; 261: 580–585.
4.
WinawerS.J., St JohnJ., BondJ.Screening of average-risk individuals for colorectal cancer. Bull World Health Organ.1990; 68: 505–513.
5.
Guide to Clinical Prevention Services: Report of the U.S. Preventive Services Task Force.2nd ed.Baltimore, Md: Williams & Wilkins; 1995.
6.
SimonJ.B.Occult blood screening for colorectal carcinoma: a critical review. Gastroenterology.1985; 88: 820–837.
7.
WinawerS.J., SchottenfeldD., FlehingerB.J.Colorectal cancer screening. J Natl Cancer Inst.1991; 83: 243–253.
8.
KronborgO., FengerC., OlsenJ.Repeated screening for colorectal cancer with fecal occult blood test: a prospective randomized study at Funen, Denmark. Scand J Gastroenterol.1989; 24: 599–606.
9.
HardcastleJ.D., ThomasW.M., ChamberlainJ.Randomised, controlled trial of faecal occult blood screening for colorectal cancer: results for first 107,349 subjects. Lancet.1989; 1: 1160–1164.
10.
AllisonJ.E., FeldmanR., TekawaI.S.Hemoccult screening in detecting colorectal neoplasm: sensitivity, specificity and predictive value. Long-term follow-up in a large group practice setting. Ann Intern Med.1990; 112: 328–333.
11.
MandelJ.S., BondJ.H., ChurchT.R.Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med.1993; 328: 1365–1371.
12.
LevinB., HessK., JohnsonC.Screening for colorectal cancer: the impact of rehydration on the Hemoccult fecal occult blood test. Gastroenterology.1995; 108: A496.
13.
KronborgO., FengerC., WormJ.Causes of death during the first 5 years of a randomized trial of mass screening for colorectal cancer with fecal occult blood test. Scand J Gastroenterol.1992; 27: 47–52.
14.
LangC.A., RansohoffD.J.Fecal occult blood screening for colorectal cancer: is mortality reduced by chance selection for screening colonoscopy?JAMA.1994; 271: 1011–1013.
15.
WinawerS.J., ZauberA.G., HoM.N.Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med.1993; 329: 1977–1981.
16.
St JohnD.J., YoungG.P., AlexeyeffM.A.Evaluation of new occult blood tests for detection of colorectal neoplasia. Gastroenterology.1993; 104: 1661–1668.
17.
FearonE.R., VogelsteinB.A genetic model for colorectal tumorigenesis. Cell.1990; 61: 759–767.
18.
SidranskyD., TokinoT., HamiltonS.R.Identification of ras oncogenes in the stool of patients with curable colorectal tumors. Science.1992; 256: 102–105.
19.
Smith-RavinJ., EnglandJ., TalbotI.C.Detection of c-Ki-ras mutations in faecal samples from sporadic colorectal cancer patients. Gut.1995; 36: 81–86.
20.
SorensonG.D., PribishD.M., ValoneF.H.Soluble normal and mutated DNA sequences from single-copy genes in human blood. Cancer Epidemiol Biomarkers Prev.1994; 3: 67–71.
21.
SelbyJ.V., FriedmanD.G., QuesenberryC.P.Jr. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med.1992; 326: 653–657.
22.
NewcombP.A., NorfleetR.G., StorerB.E.Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst.1992; 84: 1572–1575.
23.
RexD.K., LehmanG.A., UlbrightT.M.The yield of a second screening flexible sigmoidoscopy in average-risk persons after one negative flexible examination. Gastroenterology.1994; 106: 593–595.
24.
GohaganJ.PLCO Cancer Screening Trial.1995 (personal communication).
25.
AtkinW.S., CuzickJ., NorthoverJ.M.Prevention of colorectal cancer by once-only sigmoidoscopy. Lancet.1993; 341: 736–740.
26.
WinawerS.1995 (personal communication).
27.
GelfandD.W., OttD.J.The economic implications of radiologic screening for colonic cancer. AJR Am J Roentgenol.1991; 156: 939–943.
28.
ViningD.1994 (personal communication).
29.
AhlquistD.A.Occult blood screening: obstacles to effectiveness. Cancer.1992; 70: 1259–1265.
30.
WagnerJ.L., HerdmanR.C., WadhwaS.Cost effectiveness of colorectal cancer screening in the elderly. Ann Intern Med.1991; 115: 807–817.
31.
LiebermanD.A.Cost-effectiveness model for colon cancer screening. Gastroenterology.1995; 109: 1781–1790.