ROCKVILLE, Md--In the first report issued under its new Evidence-based Practice Initiative, the Agency for Health Care Policy and Research (AHCPR) has reaffirmed that early detection and treatment provide the primary means of preventing death from colorectal cancer.

Among the conclusions of the report, based on a review of 3,500 citations from the scientific literature (1966 to 1994):

• Use of fecal occult blood testing followed by diagnostic evaluation and treatment for positive tests can cut colorectal cancer mortality by 15% to 33%.
• A 60-cm flexible sigmoidoscopy identifies nearly all cancers and polyps greater than 1 cm in diameter and 75% to 80% of small polyps.
• Sigmoidoscopy screening can reduce colorectal cancer mortality risk by 59% to 80%.
• Indirect evidence supports the use of double-contrast barium enema in screening for colorectal cancer.
• While screening colonoscopy offers the potential to both identify and remove cancers and premalignant lesions, no studies completed to date show an associated mortality reduction.
• Detecting and removing polyps reduces the incidence of colorectal cancer, and removing early cancers lowers mortality. Although both double-contrast barium enema and colonoscopy detect polyps and tumors, they have not been studied as screening tests.

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