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Although colonoscopy is promoted widely in the U.S. for colorectal cancer screening, no completed large-scale randomized trials have been performed to compare flexible sigmoidoscopy with colonoscopy or to compare either procedure with no screening. The U.S. Preventive Services Task Force recommends strategies based on either approach or on fecal occult blood testing (FOBT), allowing some leeway in choice of tests (JW Gen Med Oct 28 2008). In contrast, the U.K.'s national screening program, launched in 2006, is based on initial FOBT screening.
More than a decade ago, British investigators randomized 170,000 patients in selected general practices either to undergo one flexible sigmoidoscopy between age 55 and 64 or to receive no screening. Sma…