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- Page navigation anchor for RE: Colorectal cancer screening: It is not time for a radical shift.RE: Colorectal cancer screening: It is not time for a radical shift.
We respectfully object to the interpretation of our commentary as one that would promote withholding information from screening participants. We essentially sought to express concerns about the proposed guidelines because they entailed serious limitations, on multiple levels, best described by the authors themselves as follows: “The process of making these recommendations was challenging, often with opposing views in the panel. Particular challenges were the lack of randomised trials for colonoscopy and FIT (which made us rely on modelled estimates of low certainty for screening benefit) and the uncertainty in people’s values and preferences.” (1) We stand by our assertion that this guideline project lacks the credibility to justify a drastic change in colorectal cancer screening philosophy in the face of robust evidence for efficacy of organized screening.
Reference
1. Helsingen LM, Vandvik PO, Jodal HC, et al. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline. BMJ 2019;367:l5515.Competing Interests: Catherine Dubé is contracted by Ontario Health (Cancer Care Ontario) for the role of clinical lead for the ColonCancerCheck program, Ontario’s colorectal cancer screening program. - Page navigation anchor for RE: The Future of Colorectal Cancer Screening: Parentalism or Shared Decision MakingRE: The Future of Colorectal Cancer Screening: Parentalism or Shared Decision Making
Michael Bretthauer1, Lise M. Helsingen1, Per-Olav Vandvik2,3, Mette Kalager1, Thomas Agoritsas4, Gordon Guyatt5
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1Clinical Effectiveness Research group, 1University of Oslo and Oslo University Hospital Oslo, Norway
2Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
3Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
4Division General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
5Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
In their commentary in the Journal, Bielawska and Dubé (1) criticize our recent colorectal cancer screening guideline in The BMJ (2). They reason that because screening is effective in reducing colorectal cancer incidence and mortality, screening programs need to be implemented, and all individuals in the target group (defined by age) should participate. For those who are reluctant to participate, “risk calculators and decision aids can (…) be helpful (…) as targeted interventions to enhance screening uptake (…)” (1).
We believe that people are entitled to know the answer to the following questions to make a decision about screening:
1. What is my risk of the disease and/or dying from it?
2. How much do I reduce my risk if I participate in screening?
3. What are the harms and burdens of screening participation?
One of the reasons our guideline has different r...Competing Interests: None declared.