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Big Drop in Colon Cancer Attributed to Colonoscopy

'Dramatic' Declines continued...

The rate of operations in the lower part of the colon fell from 38.7 per 100,000 people in 1993 to 23.2 in 2009. While the resection rate in the upper part of the colon fell from 30 per 100,000 people in 1993 to 22.7 in 2009, it declined significantly only after 2002.

Ladabaum’s team attributes the decline to the wider use of colonoscopy.

“[It] is fairly logical,” says Brenda Edwards, PhD, a senior advisor for cancer surveillance at the National Cancer Institute in Bethesda, Md. She wasn’t involved with the study. Still, “as they point out, this is not a cause-and-effect kind of thing,” Edwards says, because patients weren’t randomly assigned to colonoscopy or another screening test.

High Tech vs. Low Tech

Colorectal cancer cases and deaths have declined because of screening, but “the question is, could we do it cheaper with stool blood testing?” asks Otis Brawley, MD, chief medical officer for the American Cancer Society.

Testing for microscopic blood in stool costs only $30, compared to $3,000 for a colonoscopy, Brawley says. Back in 2000, researchers reported that screening with the stool blood test every one or two years cut the risk of colorectal cancer by about 20%. That finding stemmed from 18 years of follow-up of more than 46,000 people, ages 50 to 80, who’d been assigned to screening with the stool blood test every year or every two years, or to their doctor’s usual care, which typically was no screening.

“We don’t have science that good [with] colonoscopy, which may surprise a lot of people,” Brawley says.

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