Breast cancer expert Dr. Susan Love wrote on her Facebook page last week:
“Had my routine colonoscopy today…did you know that there is no study showing that screening colonoscopy is better than sigmoidoscopy in reducing deaths from colon cancer…. and yet the beat goes on.”
She also linked to a public radio Marketplace piece, “Should the colonoscopy be the ‘gold standard’?“
We’re starting to hear this question more often.
And many times, it’s being asked by Dr. James Allison, an emeritus professor at the University of California-San Francisco in the Division of Gastroenterology.
Last week he wrote to colleagues on the California Colorectal Cancer Coalition about new American Cancer Society colorectal screening guidelines. Excerpt of his email letter:
“I was optimistic when I saw the headline today but it appears this “new” screening guideline looks exactly like the old one. It once again puts out the statement not supported by the available evidence that structural exams detect and prevent cancer but fecal tests (FOBT/FIT) do not.
Tests continue to be recommended that have not, after careful CMS (Center for Medicare & Medicaid Services) review, been approved for Medicare reimbursement (virtual colonoscopy, fecal DNA test), have not been FDA approved and have performance characteristics inferior to FIT or fecal immunochemical test (Mayo Clinic/NCI sponsored study-fecal DNA test), have no data suggesting efficacy (air contrast barium enema, fecal DNA test) or are no longer used very much in the U.S. (flexible sigmoidoscopy, air contrast barium enema). They also fail to mention that the increase in endoscopic screening since 2000 is almost exclusively due to colonoscopy screening and that Medicare data reveals that the use of sigmoidoscopy fell 54% from 1993 to 2003 with most of the fall occurring after Congress bypassed CMS and approved Medicare reimbursement for screening colonoscopy in 2001. Over the same period there has been a 6 fold increase in colonoscopies. Sadly, as we know too well, the vast majority of this increased screening has been in the insured population.”
He believes that the guidelines may “scare off the ever growing uninsured underserved population we are targeting for screening by saying, without evidence, that the test we recommend is inferior.”
ADDENDUM on March 15: The American Cancer Society points out that its guidelines on colorectal cancer screening were last updated in March of 2008, and have not changed in the interim. Dr. Allison’s letter to the California Colorectal Cancer Coalition referred to the ACS’ new report on Colorectal Cancer Facts and Figures, which included reference to the 2008 guidelines.