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Screening for Colorectal Cancer
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate the comments from Drs. Kirkpatrick, Budenholzer, Rosson, and Spiro. We agree with Dr. Kirkpatrick that obtaining additional data on the safety of screening colonoscopy in real-world settings is important. Resource issues, such as the capacity for performing screening colonoscopy and potential effects on the availability of the procedure for diagnostic evaluations, must also be considered (1).
Dr. Budenholzer suggests that the effectiveness of colorectal cancer screening has not been demonstrated because the available randomized trials have not shown reductions in all-cause mortality. Colorectal cancer, however, accounts for fewer than 5% of all deaths, so demonstrating a reduction in all-cause mortality is difficult both in terms of the number of patients and the amount of follow-up time required. Cost-effectiveness models necessarily attempt to project the effects of screening over longer periods and for other means of screening that have not been evaluated in randomized trials. Although they do not have the same methodologic strength as individual randomized trials, they provide useful information for much less cost.
Michael Pignone, MD
University of North Carolina; Chapel Hill, NC 27599-7110
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
