In his commentary, Richard Schabas compared various tools for colon cancer screening.1 Regarding fecal occult blood (FOB) testing, he stated that the test is “undeniably imperfect” and that “it misses almost as many cancers as it finds.” He went on to say that colonoscopy is “probably a better screening tool than FOB” and “appears to be at least as cost-effective.” Schabas concluded that we must start doing FOB testing and not colonoscopy in Canada because we believe in “the principles of equity and distributive justice.” Instead of setting a goal of increasing the capacity to offer widespread screening colonoscopy, which could significantly reduce the incidence of and mortality associated with colon cancer, Schabas suggested that we opt for a clearly inferior test and accept our “inadequate health system capacity.”
By comparison, there is no consensus on the value of mammographic screening for breast cancer, yet we are prepared to spend millions of dollars on such programs. Why should colon cancer not be regarded as at least of equal importance?
Gordon McLauchlan General Surgeon Nanaimo Regional General Hospital Nanaimo, BC
Reference
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