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In spite of the importance of screening, a government survey reported that in 2001 less than half of adults over 50 had ever had either an FOBT or endoscopy (that is, either sigmoidoscopy or colonoscopy).
Choosing between Colonoscopy and Sigmoidoscopy. The choice between the use of colonoscopy and sigmoidoscopy for routine screening for older adults with average risk is, in fact, an area of intense debate. The issues are as follows:
- Sigmoidoscopy is less costly, less invasive, quicker, and safer than colonoscopy. Although it allows inspection only of the left side of the colon, any abnormal findings from sigmoidoscopy trigger a full colonoscopy. Therefore, experts estimate that the use of sigmoidoscopy results in detecting 80% of all significant problems.
- Colonoscopy is more sensitive than any other current screening methods for detecting colon cancer. If the goal is to maximally reduce the number of cancer cases regardless of cost, colonoscopy would be the preferred approach. A landmark 1993 study reported an approximate 90% reduction in colorectal cancers in patients with precancerous polyps who were regularly screened with colonoscopy and who had all colonic polyps removed. And, no deaths were reported from cancers that were detected during screening. Colonoscopy, however, is more costly than sigmoidoscopy and carries a slightly higher risk for complications.
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