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CA: A Cancer Journal for Clinicians, Vol 30, 208-215, Copyright © 1980 by American Cancer Society

Cancer of the Colon and Rectum

As in the case of lung cancer, the precise value of early detection of colon cancer is not easily determined. Three studies indicate that early detection will reduce mortality. The most important is a controlled study conducted by the Kaiser Health Plan that showed a significant reduction in colon cancer mortality with screening by digital examination and sigmoidoscopy. This occurred despite the fact that only about one-third of the screened persons received annual sigmoidoscopies. The other two studies were uncontrolled but showed very high (over 90 percent) long-term (15-year) survival of patients screened with sigmoidoscopy. The duration of the followup and the extremely high case-survival rate make it unlikely that the effect is due solely to the lead time or patient selection biases.

There are no controlled studies at present that demonstrate the value of the stool guaiac slide test. However, several studies show conclusively that the test can detect cancers in an earlier stage, and when this is coupled with the results of other studies that indicate a reduction in mortality associated with earlier detection, the recommended protocol appears advisable. It should be clear, however, that the available data are inconclusive, that these recommendations should be considered only guidelines to be tailored to fit the needs of individual persons, and that the evidence of benefits as well as the potential risks and costs should be carefully described before the tests are used.

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