Re: Colorectal Cancer Screening: Sifting Through the Evidence

Re: Colorectal cancer screening: sifting through the evidence.

In his editorial, Dr. Levin (1) states that “the report by Mandel et al. substantiates the important and clear finding that screening of men and women more than 50 years of age for colorectal cancer can save lives.” However, the article by Mandel et al. (2) clearly demonstrates that overall mortality was unaffected by screening. The cumulative allcause mortality in the annually screened group w...

Triaging suicidal patients: sifting through the evidence.

The triaging of individuals who present to general hospital emergency departments with suicidal thoughts and behaviours is especially challenging and fraught with uncertainty. Although the suicide literature is vast, and risk factor research has a long history, there is a dearth of articles that address the "point of care" factors that need to be considered in triaging a suicidal patient. In or...

Sifting through the first evidence for inflation

Re: improving the cost-effectiveness of colorectal cancer screening.

In an earlier issue of the Journal, we showed that sigmoidoscopy screening for colorectal cancer might result in net cost savings under expert-based assumptions (1). Although savings start to exceed costs after 22 years, it takes about 45 years for a continuing screening program to be compensated by savings before all costs. A screening program that terminates after 30 years will achieve net co...

Re: Alternatives to colonoscopy for population-wide colorectal cancer screening.

Colorectal cancer is one of the top three cancers in the world in terms of incidence. Colonoscopy, which many regard as the gold standard in diagnosis of colonic polyps and neoplasm, is costly, invasive and labour-intensive, and deemed an unsuitable population-wide index screening tool. Alternative modalities, including guaiac and immunohistochemical faecal occult blood tests, computed tomograp...