Abstract
To the Editor.— The importance of screening for colonic and rectal carcinoma is properly stressed in theMedical Newsarticle (234:137, 1975) about the wood-resin guaiac test. To say, however, that positive guaiac test results should be followed by proctosigmoidoscopy or colonoscopy improperly deemphasizes the importance of colon roentgenography. Positive guaiac testing should certainly be followed by proctosigmoidoscopy, and a barium enema should be done even if proctosigmoidoscopy shows abnormality because (1) the extent of the lesion can best be determined roentgenographically and (2) synchronous carcinomas are not rare. Colonoscopy has serious drawbacks that argue against its use in any large screening effort. It is quite expensive and time-consuming and generally requires patient hospitalization. Furthermore, because of difficulty passing the endoscope, the entire colon is visualized only about 85% of the time in normal patients. This figure is even smaller in the presence of colonic narrowing, either benign or malignant.
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