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Black, White, or Shades of Gray?

Hemant K. Roy, MD; Laura K. Bianchi, MD

JAMA. 2008;300(12):1459-1461.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Colorectal cancer screening may affect public health through both early diagnosis and actual cancer prevention via identification and colonoscopic removal of precursor lesions (adenomatous polyps).¹ However, currently only half of the eligible population undergoes colorectal cancer screening.² Moreover, many of these patients undergo evaluation with tests that are insensitive for detecting adenomatous polyps. Therefore, despite being eminently preventable, colorectal cancer still ranks as the second leading cause of cancer deaths in the United States.¹

Traditional approaches to screening dichotomize the population into increased-risk (eg, personal or family history or conditions such as ulcerative colitis) or average-risk (50 years) groups. The most recent guidelines categorize the available screening options as those that primarily identify cancers vs those that may also detect adenomas (with implications for colorectal cancer prevention).¹ Generally, tests with higher patient acceptability lack sensitivity, whereas the more accurate tests are . . . [Full Text of this Article]

Author Affiliations: Department of Internal Medicine, Evanston Northwestern Healthcare, Evanston, Illinois.

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