Contrary to the headline of the article, "Screening procedure fails to prevent colon cancer deaths in large US study" (Oct 10), the Society of Colorectal Surgeons, Singapore would like to emphasise that colonoscopy screening remains the best proven method to reduce the risk of colorectal cancer.

The article reports outcomes of the Nordic-European Initiative on Colorectal Cancer trial released on Oct 9 in The New England Journal of Medicine.

The study split participants from Norway, Poland and Sweden into two groups - one was invited to undergo colonoscopy screening while the other was not. Of the patients in the first group, only 42 per cent actually went for the procedure.

In this group invited for screening, the risk of colorectal cancer at 10 years was lower (risk reduction of 18 per cent) among participants in comparison with the group that did not have a colonoscopy.

What the study does point out, however, is that those diagnosed with colorectal cancer in both groups had similar mortality rates.

As in all studies, there are limitations in the analysis and interpretation of results. In many screening studies, as participation is voluntary, there is selection bias. The study group here is also older (55 to 64 years old) and one can question whether they were truly symptom-free prior to the colonoscopy.

Nonetheless, the study is thought-provoking and emphasises how healthcare administrators and doctors have to continue to encourage people to go for screening for colorectal cancer prevention.

Colorectal cancer remains the No. 1 cancer in Singapore. In the United States, screening guidelines have shifted to a younger age of 45 in view of an increasing trend of younger colorectal cancer incidence.

In Singapore, the cancer registry data continuously shows that the majority of cancers are diagnosed late, at the advanced stages of 3 and 4. The catastrophic impact to individuals and families, as well as the healthcare resources utilised to treat cancer and maintain quality of life, is not small.

Colonoscopy screening has been proven to decrease the risk of colorectal cancer and its associated suffering and costs to the patients and healthcare system.

We applaud the initiatives that the Government is taking to promote cancer prevention with the Healthier SG initiative, and urge both men and women to be proactive in colorectal cancer screening.

Chew Min Hoe (Dr)

President

Society of Colorectal Surgeons, Singapore

and exco members