Title: Colorectal cancer screening
Running head: colorectal cancer
Shih-Wei Lai 1,2; Kuan-Fu Liao 3,4,5; Hsueh-Chou Lai 6,7
School of Medicine, 3Graduate Institute of Integrated Medicine, and 6School of
Chinese Medicine, China Medical University, Taichung, Taiwan
Department of Family Medicine, and 7Department of Internal Medicine, China
Medical University Hospital, Taichung, Taiwan
Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung,
Department of Health Care Administration, Central Taiwan University of Science
and Technology, Taichung, Taiwan
(The first two authors contributed equally to this study.)
Hsueh-Chou Lai, Department of Internal Medicine, China Medical University
Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan
We read one meta-analysis with great interest recently published in Aliment
Pharmacol Ther, Hassan and colleagues reported that the detection rate of advanced
neoplasia was higher with colonoscopy (relative risks = 3.56, 95% CI = 1.79-7.09)
than that with faecal tests.1 In our cross-sectional study in Taiwan, 6 subjects
(0.14%) were found to have rectosigmoid adenocarcinomas among 4413 subjects
undergoing flexible sigmoidoscopy during self-referred health examinations between
2001 and 2004.2 A population-based study using the Taiwan Cancer Registry database
has shown that 25% of total colorectal cancers were located at right-sided colon.3
Therefore, flexible sigmoidoscopy cannot detect all of colorectal cancers.
Based on Hassan et al.’s and our findings, colonoscopy should be superior to
sigmoidoscopy and faecal tests for detection of colorectal cancer in a screening
Guarantor of the article: Shih-Wei Lai is acting as the submission’s guarantor (i.e.
the person who takes responsibility for the integrity of the work as a whole, from
inception to published article.)
Author contributions: Shih-Wei Lai provided substantial contributions to the
conception of this article; planned and conducted the study; initiated the draft of
the article. Kuan-Fu Liao, Hsueh-Chou Lai and Shih-Wei Lai critically revised the
All authors approved the final version of the manuscript.
Declaration of personal interests: The authors disclose no conflicts of interest.
1. Hassan C, Giorgi Rossi P, Camilloni L, et al. Meta-analysis: adherence to
colorectal cancer screening and the detection rate for advanced neoplasia, according
to the type of screening test. Aliment Pharmacol Ther 2012; 36: 929-40.
2. Liao KF, Lai HC, Lai SW, Cheng KC, Lin CH. Association between
rectosigmoid adenomas and cardiovascular risk factors: a hospital-based,
cross-sectional study. Ann Acad Med Singapore 2009; 38: 630-6.
3. Chen TA, Kang HY, Chang HC, Lin WC, Chao TM, Horng JT. Gender
differences in colorectal cancer during the past 20 years in Taiwan. Int J Colorectal
Dis 2012; 27: 345-53.