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- Page navigation anchor for RE: Jordan, TM, The future of colorectal cancer screening: "Parentalism or shared decision-making?"RE: Jordan, TM, The future of colorectal cancer screening: "Parentalism or shared decision-making?"
I disagree with two comments by Jordan. Firstly that colorectal cancer screening is “shutting the stable door after the horse has bolted”, and secondly, “do we adequately take into account the morbidity and occasionally the mortality which stems from screening and also the expense”?
Contrary to Jordan's equine metaphor, colorectal cancer screening provides an opportunity to intervene, both with detection and removal of precancerous lesions, and detection of cancer at an earlier stage (and with reduced mortality) than would otherwise occur, if one waited for symptoms. Unlike screening for breast cancer and prostate cancer, the evidence for colorectal cancer screening is very strong, (albeit still lacking RCT’s for colonoscopy). The “morbidity” of fecal immunochemical testing (FIT) is minimal, with the caveat that a positive result will result in a colonoscopy. The mortality rate for colonoscopy is currently thought to be one in 10,000 or less. There is morbidity, but far less than the morbidity and mortality of colorectal cancer.
Evidence that “efforts should be spent on helping to change lifestyles in attempts at preventing colorectal cancer” is currently lacking, but physicans interested in preventing death from colorectal cancer, also spend considerable time advising patients on diet and lifestyle to reduce risk, despite weak evidence for efficacy.
Cost-effectiveness of colorectal cancer screening has been clearly demonstrated in North Americ...
Show MoreCompeting Interests: None declared.References
- . RE: Jordan, TM, The future of colorectal cancer screening: "Parentalism or shared decision-making?". 2020;:-.
- Page navigation anchor for RE: The future of colorectal cancer screening: "Parentalism or shared decision-making?"RE: The future of colorectal cancer screening: "Parentalism or shared decision-making?"
I must congratulate the response to the original article by our Norwegian, Swiss and Canadian authors, who seem to have nailed it. Canada is a very patronising society, with those who think they know, demanding of action, lest they think someone will be harmed.
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I have always wondered whether much of this thinking stems from an often unconscious self-interest more than a deliberate attempt at manipulation. Demanding of adherence to guidelines or anything for that matter which is thought to be in someone's best interest, may often be an attempt in demanding a need for greater funding in dollar terms, all in the name of protecting and saving lives, which all helps to protect one's job. 'Saving lives' has a remarkable effect on those who disburse the monies for the requisite action to be taken, but it also helps mobilise and motivate those who have a very narrow self-interest.
Greater efforts should be spent on helping to change lifestyles in attempts at preventing colo-rectal cancer, rather than waiting to 'shut the stable door, after the horse has bolted'.
We work in a health service which demands funding, irrespective of the outcome, but the finite life of a patient cannot be worth an inestimable dollar figure, for that surely compromises the health of others, as resources are limited and must always be rationed. That is one of the ineluctable laws of nature.
We work in a health service that helps to medicalise patients...Competing Interests: None declared.References
- . RE: The future of colorectal cancer screening: "Parentalism or shared decision-making?". 2020;:-.