COST-BENEFIT OF EARLY DIAGNOSIS OF COLORECTAL-CANCER

In most Western countries, colorectal cancer is an important disease i n terms of morbidity and mortality. As it has a premalignant asymptoma tic stage in the form of benign adenomas that might be detected by scr eening, and as screening leads to detection of colorectal cancer at an earlier stage, there is potential for improved and better quality sur vival. Most cost-effective analyses rank the various screening strateg ies at less than an accepted benchmark value of approximately $40,000 per added year of life, Periodic colorectal screening is therefore a c ost-effective intervention and the Office of Technology Assessment of the Congress of the United States has concluded that colorectal cancer screening in average-risk adults beginning at age 50 is a relatively good investment for society. Flexible sigmoidoscopy and double contras t barium enema are the most cost-effective strategies but they both re quire colonoscopy if a lesion is identified. Colonoscopy at 10-yearly intervals is of comparable cost to flexible sigmoidoscopy every 5 year s and less costly than FSIG every 3 years. Combination strategies, usi ng faecal occult blood testing with periodic flexible sigmoidoscopy or double contrast barium enema are as costly as colonoscopy. The choice of screening strategies needs to be tailored to the individual, and a process of community education is an essential prerequisite to the su ccess of any programme.