Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. Full content of the issue is available on the Internet at http://www.annals.org on October 17, 2000.

Study finds colonoscopy cost-effective in screening for colorectal cancer
A study found that colonoscopy, compared to fecal occult blood tests (FOBT) and sigmoidoscopy, is the most cost-effective way to screen for colorectal cancer (Article, p. 573). FOBT detects blood in the stool; sigmoidoscopy allows examination of the rectum and lower colon; colonoscopy allows examination of the entire colon. Using a computer simulation, researchers considered administering FOBT annually, sigmoidoscopy every five years, and colonoscopy every 10 years beginning at age 50. They concluded that, despite its high total cost, colonoscopy reduces the death rate at relatively low "incremental" costs. It can prevent the cancer by removing precancerous polyps in the colon and can find colorectal cancer at early, more treatable stages, thus reducing future costs of cancer care. An editorial says the study shows that insurers will "pay now or pay later" (Editorial, p. 647). If Medicare, which pays for FOBT and flexible sigmoidoscopy, paid for colonoscopy, more lives would be saved and possibly at reduced cost, the editorial says.

Smoking is associated with kidney damage
A study of 7,476 nondiabetic people found that smokers had higher levels of a protein, albumin, in the urine and more abnormal kidney function than non-smokers (Article, p. 585). Former smokers had less albumin in the urine than smokers and no observable kidney abnor
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Contact: Penny Fuller
pfuller@mail.acponline.org
215-351-2656
American College of Physicians
16-Oct-2000