To the Editor: The study by Dr Ferlitsch and colleagues1 highlights the conundrum in using colonoscopy for population screening for colorectal cancer. The efficacy of colonoscopy with polypectomy for prevention of colorectal cancer contrasts with its inefficiency: more than 90% of colonoscopies do not find significant neoplasia and thus are devoid of cancer preventive benefits.2 This underscores the need for more accurate risk stratification to optimize the risks and benefits to individuals and the cost-effectiveness to society.
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