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In Reply: Dr Feldman and colleagues describe a new guideline by the New York City Department of Health and Mental Hygiene that recommends colonoscopy as the procedure of choice for detecting colorectal cancer. We are aware of other screening programs that have focused on promoting a particular test. For instance, health departments in North Carolina have developed a successful program that has increased rates of FOBT testing.¹ In contrast, sigmoidoscopy is the preferred procedure in an Alaska Native primary care clinic, because trained nurse endoscopists can screen large numbers of people and because the high incidence of Helicobacter pylori (and the resulting high positivity rate of FOBTs) makes testing with FOBTs not a feasible choice. After implementation of this program in a primary care clinic, screening rates increased from 16% to 47% in 1 year.²

In response to Dr Schlackman, various FOBTs are now available.³ Since repeated guiac-based FOBT reduces . . . [Full Text of this Article]

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