Is Colonoscopic Screening of a Low-Risk (Normal) Population Ethically Justifiable?

Abstract

This report summarizes the arguments for and against colonoscopic screening of a low-risk population for colorectal cancer. The strongest argument in favor of colonoscopy is that colonoscopy rarely misses an existing colorectal neoplasia and its precursor lesions and that procedural side effects are rare. In contrast, the combination of fecal occult blood test plus sigmoidoscopy leaves 10–15% of advanced neoplasms in the proximal colon undetected. However, colonoscopy is costly and the health care systems of only few European countries refund the respective costs. In addition, there is presently not sufficient manpower available to deliver colonoscopy to the public starting at the age of 50 in a 1:10 yearly frequency. Compliance to the procedure is very low even in countries which refund screening costs. Therefore, promotion of colonoscopy as the presently most effective screening procedure depends mainly on major educational efforts within the public to increase compliance as well as on the readiness of European health care systems to cover the respective costs.

Ethical issues with colorectal cancer screening—a systematic review

“…Assessing outcomes for various screening strategies is also difficult because of complexity, eg, using a noninvasive initial screening test (gFOBT or iFOBT) may increase uptake but increase anxiety and decrease efficiency. The same goes for the apparently technical question of setting cut‐off values .…”

“…Moreover, persons may balance benefits and burdens differently, eg, health care professionals and patients may value true positives and false positives differently. 32 Assessing outcomes for various screening strategies is also difficult because of complexity, 33 eg, using a noninvasive initial screening test (gFOBT or iFOBT) may increase uptake but increase anxiety and decrease efficiency. The same goes for the apparently technical question of setting cut-off values.…”