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In Reply: Dr Lev and colleagues raise concerns about perforations induced by screening. We have previously argued, however, that the study they cite overstates the incidence of perforation with screening sigmoidoscopy by 30- to 50-fold.¹ Nonetheless, improved diagnostic yields from more frequent screening must be weighed against the increased risk of complication.² Our study was a randomized, community based study of screening for cancer. As in any study based on voluntary enrollment, participants do not exactly match the general population from which they are drawn. But by virtue of our study's geographic diversity and size, findings and conclusions from the study well represent the consequences and impact of screening in the population. Lack of compliance with screening or follow-up of suspicious lesions are inevitable and expected, and mirror the process in the clinical setting. Futhermore, inadequate follow-up underestimates the rate of cancer and diagnosis of advanced adenoma.

Drs Sonnenberg and . . . [Full Text of this Article]

Robert E. Schoen, MD, MPH; Joel L. Weissfeld, MD, MPH
Departments of Epidemiology and Medicine
University of Pittsburgh
Pittsburgh, Pa

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