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Screening, not early diagnosis, may be the best approach
Colorectal cancer is the second commonest cause of cancer in the UK with over 30 000 new cases each year. The overall five year survival rate of 40%,1 together with well published regional variations in outcome, increased public awareness and expectation have prompted a careful look at the management of this disease. Late presentation remains one of the key areas of concern, and there are a number of proposed approaches designed to increase the proportion of patients for whom cure is a realistic goal. The first is to offer screening to the population as a whole, the second to offer screening to individuals in high risk groups, and the third rapid diagnosis of symptomatic patients.
Colorectal cancer readily fulfils the criteria for mass screening: a high incidence, outcome affected by stage of disease and modified by early intervention, and adenomatous polyps as an identifiable precancerous lesion. However, a truly appropriate and valid screening test remains elusive and the ability of an overstretched health care system to provide such a “gold standard” investigation remains in doubt.
In 1996 the Nottingham group screened 152 850 participants with faecal occult blood tests and increased the proportion of patients with Dukes A carcinoma in the screened population from 11% to 20% and decreased the percentage of patients with stage C or D from 52% to 46% compared with controls. …
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