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Detection and Surveillance of Colorectal Cancer

Mark W. Ragozzino, MD
JAMA. 1990;263(3):374. doi:10.1001/jama.1990.03440030057017.
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To the Editor.—  JAMA was remiss in publishing the self-serving article entitled "Detection and Surveillance of Colorectal Cancer."1 An accompanying editorial by Dr Clayman,2 however, does note that "an objective observer would almost surely differ with the advice offered."The problem of colon cancer must first be placed in perspective. The general consensus is that colon carcinoma arises from adenomatous polyps. However, only 1% to 2% of polyps 6 mm to 1 cm are malignant and 5% of polyps 1 cm to 2 cm are malignant.3 Search and biopsy/fulguration of polyps smaller than 5 mm "would result in immense monetary costs, as well as in mortality and morbidity rates of a degree ethically unacceptable in view of any potential benefits."4The sensitivity of double-contrast barium enema examination for detection of polyps larger than 1 cm is 82% to 98%.3 The sensitivity of double-contrast barium enema


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