The Boston Globe says in an editorial:

For years, doctors have been recommending that patients with a family history of colon cancer or with any symptoms of the disease undergo a colonoscopy examination. For patients 50 or older with no special risk of getting the disease, doctors typically recommend the less-costly sigmoidoscopy of just the lowest third of the large intestine.

Now the rationale for the less-intrusive procedure has been shaken by two studies showing that one-half of all patients with cancer or precancerous polyps in the higher part of their colon had no evidence of them in the lower section. Their condition was only detected when they were given a colonoscopy; they would have been given a clean bill of health by a sigmoidoscopy.

The findings - based on tests of 5,100 patients - will force doctors, insurers and the public to rethink the way they go about prevention and early detection of this disease, the second biggest cancer killer after lung cancer.

``I believe,'' writes Dr. Daniel K. Podolsky of Massachusetts General Hospital in an editorial in the New England Journal of Medicine, ``it is time for both government and private insurers to provide coverage for colonoscopic screening for all persons 50 years of age or older ...''

But getting insurers to pay the sizable bill for widespread colonoscopy screening is just part of the problem. As things stand now, fewer than one third of all persons over 50 undergo either test, even though many insurers cover one or both procedures. There are several reasons behind this, ranging from doctors' failure to encourage patients to be screened to the unpleasantness of the procedure. And if colonoscopy, which requires more expertise than sigmoidoscopy, became routine now, there would not be enough specialists to do it.

Still, Dr. Podolsky's position is hard to dispute. The new studies show how successfully colorectal cancer can be screened for. Caught early, both cancerous and precancerous growths can be removed and lives saved. Now it is up to society as a whole to decide if it wants to make this kind of commitment.

(From HealthWorld Online)