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To the Editor: The study by Dr Schoen and colleagues¹ suggests that important opportunities to prevent colon cancer may be missed with a 3-year flexible sigmoidoscopy interval, let alone with the 5-year interval recommended by most guidelines. These data, however, do not necessarily apply to colonoscopy, a test that is done with sedation and a more complete bowel preparation.

This study does, however, lend weight to the American Cancer Society colorectal cancer screening guidelines, which recommend that the combination of an annual fecal occult blood test (FOBT) and flexible sigmoidoscopy every 5 years is preferred over either test alone.² Clinical trials of FOBT screening have found that mortality rates from colorectal cancer may be reduced by 33% and that incidence may be reduced by approximately 20%.^3-4 The test characteristics of fecal immunochemical tests for occult blood may further improve the usefulness of screening with stool tests.^{2, 5}

The annual FOBT remains . . . [Full Text of this Article]

Richard C. Wender, MD
Department of Family Medicine
Thomas Jefferson University
Philadelphia, Pa

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